NT-proBNP Concentration and Early Cardiac Dysfunction in Patients Receiving Dialysis: A Prospective Cohort Study

Introduction:The significance of N-terminal pro-B type natriuretic peptide (NT-proBNP) to detect heart failure in patients with end-stage kidney diseases on dialysis is controversial.Objective:To assess whether serial measurements of NT-proBNP can predict worsening cardiac function in dialysis patients.Methods:In this prospective, longitudinal, observational cohort study, the relationship between changes in monthly plasma NT-proBNP concentrations and changes in echocardiographic indices (left ventricular global longitudinal strain [GLS] and ejection fraction [LVEF]) were analyzed in dialysis patients without symptoms of heart failure over 24 months using multilevel mixed effects models.Results:The study included 40 dialysis patients who were followed for a median period of 24 months. Logarithmically transformed baseline plasma NT-proBNP levels were correlated positively with GLS (r= 0.48,p= 0.002) and negatively with LVEF (r= -0.44,p= 0.005). Time-averaged and maximum NT-proBNP values during the echocardiogram intervals were significantly correlated with GLS and LVEF over time. Every 1-unit increase in average NT-proBNP level during the echocardiogram interval was associated with a 0.99 (95% confidence interval, 0.41-1.56) higher GLS (%) and 2.90 (1.22-4.57) lower LVEF (%). Every 1-unit increase in maximum NT-proBNP level was associated with a 0.90 (0.35-1.45) higher GLS (%) and 2.67 (1.03-4.30) lower LVEF (%). This increase in GLS indicates a reduction in systolic performance.Conclusions:Our cohort study demonstrated that serial plasma NT-proBNP concentrations may be useful for early identification of individuals with worsening cardiac function over time.