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European Heart Journal Advance Access published online on July 9, 2008
European Heart Journal, 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
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org.

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.

* 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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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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