The interaction between N-terminal pro-brain natriuretic peptide and fluid status in adverse clinical outcomes of late stages of chronic kidney disease

• Published in: PloS one 2018-08, Vol.13 (8), p.e0202733-e0202733
• Main Authors: Tsai, Yi-Chun, Tsai, Hui-Ju, Lee, Chee-Siong, Chiu, Yi-Wen, Kuo, Hung-Tien, Lee, Su-Chu, Chen, Tzu-Hui, Kuo, Mei-Chuan
• Format: Article
• Language: English
• Subjects: Aged; Analysis; Biology and Life Sciences; Biomarkers; Biomarkers - blood; Body Composition; Brain; Brain natriuretic peptide; Cardiovascular diseases; Cardiovascular Diseases - mortality; Care and treatment; Chronic kidney failure; Clinical outcomes; Complications; Dialysis; Dialysis - methods; Dialysis - statistics & numerical data; Enzymes; Female; Fluids; Glomerular Filtration Rate; Health aspects; Heart failure; Hemodialysis; Hospitals; Humans; Internal medicine; Kidney - metabolism; Kidney - physiopathology; Kidney diseases; Kidneys; Male; Medical records; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; Natriuretic Peptide, Brain - blood; Natriuretic peptides; Nephrology; Outcome and process assessment (Medical care); Patient outcomes; Patients; Peptide Fragments - blood; Peptides; Physiological aspects; Prognosis; Renal function; Renal Insufficiency, Chronic - metabolism; Renal Insufficiency, Chronic - mortality; Renal Insufficiency, Chronic - therapy; Rheumatoid arthritis; Spectrum analysis; Systematic review; Treatment Outcome; Urine
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0202733

Fluid overload is one of the major characteristics and complications in patients with chronic kidney disease (CKD). N-terminal pro-brain natriuretic peptide (NT-proBNP) is related to fluid status and fluid distribution. The aim of this study is to investigate the interaction between NT-proBNP and fluid status in adverse clinical outcomes of late stages of CKD. We enrolled 239 patients with CKD stages 4-5 from January 2011 to December 2011 and followed up until June 2017. Fluid status was presented as hydration status (HS) value measured by body composition monitor, while HS>7% was defined as fluid overload. Clinical outcomes included renal outcomes (commencing dialysis and estimated glomerular filtration rate decline>3 ml/min/1.73 m2/year), all-cause mortality and major adverse cardiovascular events (MACEs). During a mean follow-up of 3.3±2.0 years, 129(54.7%) patients commenced dialysis, 88(37.3%) patients presented rapid renal function decline, and 48(20.3%) had MACEs or died. All patients were stratified by HS of 7% and the median of plasma NT-proBNP. The adjusted risks for commencing dialysis was significantly higher in patients with high plasma NT-proBNP and HS>7% compared to those with low plasma NT-proBNP and HS≦7%. There was a significant interaction between plasma NT-proBNP and HS in commencing dialysis (P-interaction = 0.047). Besides, patients with high plasma NT-proBNP and HS>7% had greater risks for MACEs or all-cause mortality than others with either high plasma NT-proBNP or HS>7%. NT-proBNP and fluid overload might have a synergistic association of adverse clinical outcomes in patients with late stages of CKD.