Renal Replacement Therapy (Sep 2019)
Prognostic markers of heart failure in patients undergoing peritoneal dialysis
Abstract
Abstract Background Heart failure is a significant cause of death and hospitalization in dialysis patients. Controlling the volume status in PD, especially, is difficult, and transferring the PD patients to hemodialysis results mainly from ultrafiltration failure. Thus, the control of heart failure and markers as its predictors in PD patients are of the utmost importance. In this study, we aim to confirm the utility of BNP and NT-proBNP as predictive markers of heart failure and to identify new markers in PD patients. Methods Our study involved 29 patients who had been undergoing PD. The following were determined: body mass index, primary disease, PD vintage, D/P ratio, D/D ratio, left ventricle ejection fraction, left atrial dimension, left ventricular mass index, cardiac index, change in body weight, CTR, BNP, NT-proBNP, BUN, creatinine, TP, Alb, Na, K, Cl, Ca, P, iPTH, Hb, Ht, sβ2MG, T-SAT, and weekly Kt/V urea and CCr. Furthermore, we categorized the patients’ disease using the NYHA classification and evaluated these indicators. Results The BNP concentration was positively correlated with that of NT-proBNP. In addition, the CTR was positively correlated with BNP and NT-proBNP concentrations. By one-way analysis of variance, the NYHA classification was statistically associated with BNP, NT-proBNP, CTR, Alb, Hb, Ht, sβ2MG, ferritin, and weekly Kt/V urea and CCr, of which Hb and Ht were the most significant. According to the logistic regression analysis of the heart failure risk using the NYHA classification, the CTR, Hb, Ht, and weekly CCr were statistically significant in the univariate analysis. However, none remained statistically significant, and among them, weekly CCr has the highest specificity in the multivariate analysis. Furthermore, the following measurements were associated with a high risk of heart failure: CTR > 51.9%, Hb < 9.4 g/dL, Ht < 29.2%, and weekly CCr < 80.9 L/week/1.73 m2. Conclusion Compared with the classical examinations, BNP and NT-proBNP are less useful as markers of heart failure in PD patients. Consequently, anemia and weekly CCr are the risks of heart failure. Trial registration This study was retrospectively registered to the University Hospital Medical Information Network (UMIN no. 000041762).
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