Abstract
Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a useful cardiac biomarker that is associated with acute kidney injury (AKI) and mortality after cardiac surgery. However, its prognostic value in cardiac surgical patients receiving renal replacement therapy (RRT) remains unclear.Objectives: Our study aimed to assess the prognostic value of NT-proBNP in patients with established AKI receiving RRT after cardiac surgery.Methods: A total of 163 cardiac surgical patients with AKI requiring RRT were enrolled in this study. Baseline characteristics, hemodynamic variables at RRT initiation, and NT-proBNP level before surgery, at RRT initiation, and on the first day after RRT were collected. The primary outcome was 28-day mortality after RRT initiation.Results: Serum NT-proBNP levels in non-survivors was markedly higher than survivors before surgery (median: 4,096 [IQR, 962.0–9583.8] vs. 1,339 [IQR, 446–5,173] pg/mL; P < 0.01), at RRT initiation (median: 10,366 [IQR, 5,668–20,646] vs. 3,779 [IQR, 1,799–11,256] pg/mL; P < 0.001), and on the first day after RRT (median: 9,055.0 [IQR, 4,392–24,348] vs. 5,255 [IQR, 2,134–9,175] pg/mL; P < 0.001). The area under the receiver operating characteristic curve of NT-proBNP before surgery, at RRT initiation, and on the first day after RRT for predicting 28-day mortality was 0.64 (95% CI, 0.55–0.73), 0.71 (95% CI, 0.63–0.79), and 0.68 (95% CI, 0.60–0.76), respectively. Consistently, Cox regression revealed that NT-proBNP levels before surgery (HR: 1.27, 95% CI, 1.06–1.52), at RRT initiation (HR: 1.11, 95% CI, 1.06–1.17), and on the first day after RRT (HR: 1.17, 95% CI, 1.11–1.23) were independently associated with 28-day mortality.Conclusions: Serum NT-proBNP was an independent predictor of 28-day mortality in cardiac surgical patients with AKI requiring RRT. The prognostic role of NT-proBNP needs to be confirmed in the future.
Highlights
Acute kidney injury (AKI) is a frequent but serious complication for patients undergoing cardiac surgery, with an increased risk of hospital mortality and prolonged length of hospital stay (1)
The modality of renal replacement therapy (RRT) included continuous venovenous hemofiltration (CVVH), continuous venovenous hemodiafiltration (CVVHDF), intermittent hemodialysis (IHD), and intermittent sustained low efficiency dialysis (SLED), which were used based on the discretion of clinicians to achieve optimal hemodynamic status and metabolic control
The cardiopulmonary bypass (CPB) time and aortic clamp time were higher in non-survivors compared to survivors
Summary
Acute kidney injury (AKI) is a frequent but serious complication for patients undergoing cardiac surgery, with an increased risk of hospital mortality and prolonged length of hospital stay (1). Patients who develop severe AKI requiring renal replacement therapy (RRT) represent nearly 2–6% of patients after cardiac surgery, and RRT dependency results in high mortality (2–6). Little is known about the prognostic value of NT-proBNP in cardiac surgery patients with established AKI. The purpose of this study was to investigate the prognostic value of NT-proBNP in cardiac surgery patients with established AKI requiring RRT. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a useful cardiac biomarker that is associated with acute kidney injury (AKI) and mortality after cardiac surgery. Its prognostic value in cardiac surgical patients receiving renal replacement therapy (RRT) remains unclear
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