N-Terminal Pro-Brain Natriuretic Peptide Predicts Long-Term Technique Failure in Patients Undergoing Peritoneal Dialysis.

Chia-Ter Chao,Jenq-Wen Huang,Chih-Kang Chiang,Kuan-Yu Hung

doi:10.3390/jcm7120557

Abstract

It is unclear whether N-terminal pro-brain type natriuretic peptide (NT-proBNP) level can be a biomarker for technique failure among long-term peritoneal dialysis (PD) patients. We prospectively included end-stage renal disease patients undergoing PD from a single center between December 2011 and December 2017. We divided the cohort into high or low NT-proBNP groups and analyzed the risk factors associated with the incidence of technique failure using Cox proportional hazard regression analysis. A total of 258 chronic PD patients (serum NT-proBNP, 582 ± 1216 ng/mL) were included. After a mean follow-up of 3.6 years, 49.6% of PD patients developed technique failure and switched to hemodialysis, while 15.5% died. Cox proportional hazard regression analyses accounting for age, gender, diabetes, renal clearance, C-reactive protein, and hydration status, showed that higher natural log transformed NT-proBNP levels (hazard ratio [HR] 1.13, p < 0.01) were predictive of an increased risk of technique failure, and were also predictive of an increased risk of mortality (HR 1.56, p < 0.01). Consequently, NT-proBNP might be an under-recognized biomarker for estimating the risk of technique failure, and regular monitoring NT-proBNP levels among PD patients may assist in their care.

Highlights

The population of patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) is increasing globally, along with the rising trend of aging population, rising incidence of hypertension, diabetes mellitus (DM), and acute kidney injury (AKI) [1,2,3]
Factors contributing to this phenomenon may include discrepancies in the reimbursement policy, physicians’ perceptions of a better hemodynamic status associated with hemodialysis, staff availability, familiarity with certain modality, and most important of all, the risk of peritoneal dialysis (PD) technique failure necessitating a switch to hemodialysis [6]
Those receiving management in a larger PD service center have a lower incidence of technique failure, while the presence of an advanced age, DM, high or high average peritoneal equilibration test (PET) status, and an increased dialysate glucose load are associated with a higher risk [8,9,10,11]

Summary

Introduction

The population of patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) is increasing globally, along with the rising trend of aging population, rising incidence of hypertension, diabetes mellitus (DM), and acute kidney injury (AKI) [1,2,3]. Among the available therapeutic modalities for ESRD, peritoneal dialysis (PD) has been found to demonstrate an early survival advantage for these patients compared to hemodialysis, conferring a better quality of life and entailing a significantly lower healthcare cost [4,5]. Despite these perceived benefits, PD is still under-utilized and less promoted in most developed countries, and it has been found that the proportion of ESRD patients receiving PD has gradually declined over time in Japan and several European countries [4]. It is suggested that fluid overload increases the risk of technique failure among chronic PD patients [13], but whether the volume-sensitive laboratory parameters play a role in modifying the risk of technique failure is still unclear

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Discussion

Conclusion