Study On The Prognostic Relevance Of B-type Natriuretic Peptide Combined With ICG Monitoring In Hemodialysis Patients

Cardiovascular disease is the main cause of morbidity and mortality in end-stage renal disease patients, accounting for approximately 50% of the deaths. B-type natriuretic peptide is a 32-amino acid polypeptide secreted by ventricles of the heart in response to excessive stretching of cardiomyocytes. This peptide played an important role in regulating blood pressure and volume through direct effects on the kidney and systemic vasculature. B-type natriuretic peptide can expand blood vessel, diuresis, natriuresis. B-type natriuretic peptide can inhibit the renin angiotensin aldosterone system. In addition, B-type natriuretic peptide may have anti myocardial fibrosis effect. BNP or NT-pro BNP has been recommended in the diagnosis and prognosis of patients with acute or chronic heart failure. Many prospective studies have investigated the link between BNP and the adverse outcomes in end-stage renal disease patients, and most found a positive association. However, the magnitudes of the association varied between studies and most of them have not been systematically assessed. In addition, interpretation of the evidence has been complicated by studies that have involved different markers, different disease outcomes(eg, all-cause mortality, cardiovascular mortality or events) and the other prognostic variables besides BNP. To help resolve this uncertainty of BNP/NT-pro BNP as a prognostic tool, our goal was to quantify the association between BNP/NT-pro BNP and long-term adverse outcomes by conducting a meta-analysis of these prospective studies.The first part: A Meta-analysis of B-type natriuretic peptide and prognosis of maintenance hemodialysis patientsObjective: At present, B type natriuretic peptide and N-terminal pro BNP is important for the prognosis of hemodialysis patients is still controversial. The primary research objective was to determine, by use of systematic review techniques, whether elevated circulating BNP and/or NT-pro BNP predicted long-term risks of all-cause mortality, cardiovascular mortality or cardiovascular events among patients with maintenance hemodialysis patients. Provide evidence-based medicine proof method to phase through the system evaluation for clinical and research work in the future.Method: We searched the Cochrane Library, Medline Database, Embase Database, CBMdisc and CEBM/CCD and 10 kinds of Chinese Medical journals until December, 2014. The related research to collect all the assessment of BNP and or NT-pro BNP and maintain the prognosis of patients with hemodialysis, research does not limit the language or whether to use the blind method. Data were extracted independently by two reviewers. The methodological quality of trails was assessed by recommended evaluation standard. Statistical analysis were performed with STATA10.0.Results: 874 papers were found using our search strategy, There were 711 articles in English and 163 articles in Chinese. 19 papers were eligible according to the inclusion criterion, a total of 6185 cases of patients. The Meta- analysis results showed that:(1) elevated BNP or NT-pro BNP and all-cause mortality increased significantly related(HR, 2.641; 95% CI, 1.735 to 4. 022).(2) elevated BNP or NT-pro BNP is associated with increased cardiovascular events related(HR, 4.35 to 7.04, 95% CI, 2.23 to 22.33).(3) increased CTn I and all-cause mortality increased significantly related(HR, 3.198; 95% CI, 1.533 to 6.585).(3) increased CRP and all-cause mortality increased significantly related(HR, 2.446; 95% CI, 1.829 to 3.272).Reviewers’ conclusions: BNP/NT-pro BNP is a promising prognostic tool to risk-stratify the patients with maintenance hemodialysis.The second part: Study on the prognostic relevance of B-type natriuretic peptid combined with ICG monitoring in maintenance hemodialysis patientsObjective: Evaluation the effect of the level of serum NT-proBNP and the change of serum NT-pro BNP on prognosis of maintenance hemodialysis patients.Method: We randomly selected 300 cases of maintenance hemodialysis patients from blood purification center in our hospital, and detected the serum NT-pro BNP concentration at the beginning of the experiment and after six months respectively. At the same time through the thoracic impedance method of noninvasive hemodynamics monitor patients were determined before dialysis cardiac output, cardiac index, stroke volume, cardiac index, acceleration index, velocity index, pleural fluid level, systemic vascular resistance. We analysis the effect of NT-pro BNP levels and the change of NT-pro BNP on the risk of patients’ Complications and mortality when they were followed up for one year.Results: A total of 300 patients with maintenance hemodialysis were enrolled, the results showed that the NT-pro BNP levels were significantly increased in these patients. The CI, CO, SV, SI, ACI, VI were measured using ICG decreased. And found the CI, CO, SI, SV, VI, LVET in group of patients using autologous arteriovenous fistula was higher than those semi permanent deep venous catheter, the p values were 0.040, 0.022, 0.007, 0.005, 0.029, 0.065, the difference was statistically significant. STR, PEP in Male patients was higher than that of female patients, while LVET was smaller than the female patients, the p values were 0.063, 0.079, 0.011, the difference was statistically significant. CI, CO, SI, SV, ACI, VI decreased with age increasing in patients, there was statistical significance in less than 74 years old patients and patients over 74 years of age, the p values were 0.013, 0.007, 0.024, 0.013, 0.005, 0.004.(1) Single factor analysis showed that the primary disease, Vascular access and the NT-pro BNP levels are associated with Cardio cerebral vascular complication in these patients, the p values were 0.022, 0.021, 0.018 and 0.005 respectively.(2) Single factor analysis showed that the primary disease, Vascular access and the NT-pro BNP levels are associated with the risk of death in these patients, the p values were 0.014,0.015,0.000 and 0.000 respectively. Logistic regression analysis showed that vascular access, the year of dialysis and the NT-pro BNP levels associated with the risk of death in patients. The death risk of patients using tunnel cuffed catheter was 2.839 times that of patients with autologous arteriovenous fistula. Dialysis period every 5 year increase in the risk of death increased by 1.232 times.The risk of death in patients with baseline NT-pro BNP greater than or equal to 5000ng/L was 3.878 times the baseline NT-pro BNP less than 5000ng/L, the risk of death in patients with NT-pro BNP greater than or equal to 5000ng/L after six months was 4.574 times that of less than 5000ng/L.(3) Kaplan-Meier survival analysis showed that NT-pro BNP more than 5000ng/L of patients with an shorter survival time than NT-pro BNP lower than 5000ng/L.(4) Within half a year, NT-pro BNP increased more than 1000ng/L group of patients with cardiovascular and cerebrovascular complications and death rate is higher than NT-pro BNP increased lower than 1000ng/L group.Conclusions: The level of NT-pro BNP in maintenance hemodialysis patients was increased. And the increased NT-pro BNP associated with the risk of cardiovascular complications and death in hemodialysis patients. The survival time of patients with NT-pro BNP than 5000ng/L group were shorter than NT-pro BNP lower than 5000ng/L group. The increase amplitude of NT-pro BNP in patients positively associated with the risk of cardiovascular complications and death. CO, CI, SV, SI, ACI, VI levels in maintenance hemodialysis patients decreased, and was associated with gender, age, vascular access.