Could N-terminal pro-BNP peptide be a useful marker for prediction of cardiac arrests in hemodialysis patients?

Abstract

To the Editor: We read with interest the article by Ostermann. They reported cardiac arrests in the dialysis unit are relatively rare events but carry a poor prognosis. The incidence of cardiac disease in dialysis patients was reported as very high, but there has been few markers to predict the cardiovascular mortality or arrhythmic events. Recently, N-terminal pro-brain natriuretic peptide (NT-proBNP) has become important diagnostic tools for assessing cardiac dysfunctions. Although not extensively studied in dialysis patients, some authors studied the relationship between cardiovascular mortality and NT-pro-BNP levels. Wang et al. reported that NT-pro-BNP was an important risk predictor of cardiovascular congestion, mortality, and adverse cardiovascular outcomes in chronic peritoneal dialysis patients, and Satyan et al. demonstrated that NT-pro-BNP level strongly correlated with left ventricular systolic dysfunction and was associated more strongly with mortality than cardiac troponin T level in asymptomatic hemodialysis patients. Furthermore, some authors showed that raised NT-pro-BNP levels predicted occurrence of symptomatic ventricular arrhythmias. Because cardiovascular disease is the main cause of morbidity and mortality in patients undergoing hemodialysis, NT-pro-BNP, a biological marker of left ventricular dysfunction, might enable us to identify high-risk asymptomatic early hemodialyzed patients, leading to aggressive evaluation of cardiac dysfunctions and appropriate, targeted therapeutic intervention.