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European Heart Journal Advance Access originally published online on July 9, 2008
European Heart Journal 2008 29(17):2092-2099; doi:10.1093/eurheartj/ehn278
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org
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Change in N-terminal-pro-B-type-natriuretic-peptide and the risk of sudden death, stroke, myocardial infarction, and all-cause mortality in diabetic dialysis patients

Karl Winkler1,*, Christoph Wanner2, Christiane Drechsler2, Jürgen Lilienthal3, Winfried März4, Vera Krane2 for the German Diabetes and Dialysis Study Investigators

1 Division of Clinical Chemistry, Department of Medicine, University Medical Center Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
2 Division of Nephrology, Department of Medicine, University Hospital, University of Würzburg, Würzburg, Germany
3 DATAMAP GmbH, Freiburg, Germany
4 Synlab Center of Laboratory Diagnostics, Heidelberg, Germany

Received 21 November 2007; revised 19 May 2008; accepted 5 June 2008; online publish-ahead-of-print 9 July 2008.

* Corresponding author. Tel: +49 761 270 3759/3617, Fax: +49 761 270 3444, Email: karl.winkler{at}uniklinik-freiburg.de

Aims: N-terminal-pro-B-type-natriuretic-peptide (NT-pro-BNP) concentrations are altered in renal failure. This study examined the effect of baseline and change from baseline NT-pro-BNP on cardiovascular outcome and mortality in haemodialysis patients.

Methods and results: On the basis of the German Diabetes and Dialysis Study, which evaluated atorvastatin in 1255 type 2 diabetes mellitus (T2DM) haemodialysis patients (median follow-up 4 years), the impact of NT-pro-BNP on pre-specified, adjudicated endpoints was investigated: sudden death (SD; n = 160), stroke (n = 99), myocardial infarction (MI; n = 200), cardiovascular events (CVEs: cardiac death, MI, stroke; n = 465), all-cause mortality (n = 612). Patients with baseline NT-pro-BNP ≥9252 pg/mL (fourth quartile) exhibited a more than four-fold risk of stroke [hazard ratio (HR) 4.1; 95% confidence interval (CI) 2.0–8.4] and a more than two-fold risk of SD (HR 2.0; 95% CI 1.2–3.3), CVE (HR 2.0; 95% CI 1.5–2.7), and mortality (HR 2.1; 95% CI 1.6–2.7) compared with patients with baseline NT-pro-BNP ≤ 1433 pg/mL (first quartile). Change in NT-pro-BNP was strongly associated with SD, CVE, and mortality. Doubling of NT-pro-BNP increased the risk of death by 46% (95% CI 1.1–2.0). Neither baseline nor change in NT-pro-BNP was significantly associated with MI.

Conclusion: Increasing NT-pro-BNP is a risk factor for SD, CVE, and mortality in haemodialysis patients with T2DM. Whether NT-pro-BNP-guided treatment improves outcome needs to be evaluated prospectively.

Key Words: NT-pro-BNP • Serial measurement • Cardiovascular events • Mortality • Haemodialysis • Diabetes mellitus


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P. A. Scott, J. Barry, P. R. Roberts, and J. M. Morgan
Brain natriuretic peptide for the prediction of sudden cardiac death and ventricular arrhythmias: a meta-analysis
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[Abstract] [Full Text] [PDF]


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