Abstract
Protein-energy wasting (PEW) is common in hemodialysis (HD) patients. A recent study demonstrated that a high level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) may be associated with PEW in those patients. This prospective study aimed to assess the association of NT-proBNP with body composition and muscle loss. A cohort of prevalent HD patients (n = 238) was examined. Blood samples were obtained at baseline to measure high-sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), adiponectin and NT-proBNP. Nutritional status and changes in muscle mass were assessed by subjective global assessment, percentage creatinine generation rate (%CGR), creatinine index (CI) and lean body mass (LBM) estimated by dual-energy X-ray absorptiometry (DXA). The %CGR and CI were calculated five times for one year, and DXA was performed at baseline and one year later. Cardiac function was estimated by ultrasonography at baseline. NT-proBNP was significantly higher in HD patients with PEW. High NT-proBNP was associated with cardiac dysfunction, increased levels of hsCRP and IL-6, and serially decreased levels of the indexes for muscle mass. Multiple regression analysis adjusted with confounders showed that NT-proBNP was an independent predictor for decrease in LBM and serial lower levels of %CGR and CI. In conclusion, the present study demonstrated a novel association between NT-proBNP and muscle loss. NT-proBNP may be an independent biomarker for malnutrition in HD patients, especially in patients with muscles loss, regardless of chronic inflammation, cardiac dysfunction, or overhydration.
Highlights
Protein-energy wasting (PEW) is common in patients who undergo hemodialysis (HD)
The present study demonstrated the association of NT-proBNP with muscle loss in malnourished HD patients, compared with high-sensitive C-reactive protein (hsCRP), IL-6 and adiponectin, which are biomarkers of PEW [21]
NT-proBNP is a biomarker for cardiac stress and fluid overload [7]; NT-proBNP levels are influenced by hydration status in HD patients
Summary
Protein-energy wasting (PEW) is common in patients who undergo hemodialysis (HD). HD patients with PEW often show decreased skeletal muscle [1], which is a phenomenon similar to that of loss of muscle mass (sarcopenia), resulting from the process of aging [2,3,4].PLOS ONE | DOI:10.1371/journal.pone.0166804 November 21, 2016NT-ProBNP and Muscle LossRecent studies have shown that a high level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with PEW and higher mortality in patients under HD [5,6]. Protein-energy wasting (PEW) is common in patients who undergo hemodialysis (HD). HD patients with PEW often show decreased skeletal muscle [1], which is a phenomenon similar to that of loss of muscle mass (sarcopenia), resulting from the process of aging [2,3,4]. Recent studies have shown that a high level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with PEW and higher mortality in patients under HD [5,6]. B-type natriuretic peptide (BNP) is produced in the cardiac ventricles in response to pressure and volume overload, and is a biomarker of cardiac failure and coronary artery disease in the general population [7]. BNP is synthesized as a proBNP; it is further cleaved into bioactive BNP and biologically inactive NT-proBNP on a one-to-one basis [7]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
