Comparison of dialysate and plasma NTproBNP in prediction of clinical outcomes ofdiabetic and nondiabetic peritoneal dialysis patients .

Abstract

Plasma level of N-terminal pro-brain natriuretic peptide (P-NTproBNP) is a useful marker in prediction of mortality in peritoneal dialysis (PD) patients. However, the predictive value of spent dialysate counterpart (D-NTproBNP) of plasma NTproBNP on mortality and dropout is not known. Simultaneous P-NTproBNP and D-NTproBNP assays were performed after an overnight dwell in 44 scheduled ambulatory PD patients. Patients were followed for ~47 months. Deceased patients or patients who were transferred to hemodialysis were regarded as dropouts. 14 patients (31.8%) dropped out at ~4 years (9deaths and 5transfers to hemodialysis). Diabetics, males, and patients with higher membrane permeability had higher dropout rates. Patients with P- and D-NTproBNP higher than median values had higher mortality and dropout rates (Kaplan-Meier test, log-rank Test p<0.05). Odds ratios of D-NTproBNP for death and dropouts were (3.807 (0.907-15.971), p=0.068) and (2.87 (1.009-8.138) p=0.048), respectively; odds ratios of P-NTproBNP for death and dropouts were (4.652 (0.914-23.693), p=0.064) and (2.67 (0.924-7.716), p=0.07), respectively; in ROC analysis for death, AUC for P- and D-NTproBNP were 0.762 (0.578-0.946, p=0.016) and 0.765 (0.590-0.940, p=0.015), respectively. Exclusion of diabetic patients from the analyses resulted in significant changes in the predictive value P- and D-NTproBNP. Although death and dropout rates were still higher in nondiabetic patients with higher NTproBNP levels, the differences between groups lost statistical significance. Both P-NTproBNP and D-NTproBNP are significant predictors of outcomes of interest. Predictive value of NTproBNP might be different in diabetics and non-diabetic CAPD patients. .