Interaction of malnutrition, N-terminal pro-B-type natriuretic peptide and ventricular remodeling in patients on maintenance hemodialysis

• Published in: Clinical nephrology Vol. 79; no. 4; p. 253
• Main Authors: Lee, Yu-Ji, Song, Bong Gun, Kim, Min Su, Cho, Seong, Chun, Woo Jung, Oh, Ju Hyun, Kim, Sung Rok
• Format: Journal Article
• Language: English
• Published: Germany 01.04.2013
• Subjects: Adult; Aged; Biomarkers - blood; Chi-Square Distribution; Cross-Sectional Studies; Echocardiography, Doppler; Female; Humans; Hypertrophy, Left Ventricular - blood; Hypertrophy, Left Ventricular - diagnosis; Hypertrophy, Left Ventricular - etiology; Hypertrophy, Left Ventricular - physiopathology; Immunoassay; Linear Models; Male; Malnutrition - blood; Malnutrition - diagnosis; Malnutrition - etiology; Malnutrition - physiopathology; Middle Aged; Natriuretic Peptide, Brain - blood; Nutrition Assessment; Nutritional Status; Peptide Fragments - blood; Predictive Value of Tests; Renal Dialysis - adverse effects; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - physiopathology; Renal Insufficiency, Chronic - therapy; Risk Factors; Ventricular Dysfunction, Left - blood; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology; Ventricular Remodeling
• ISSN: 0301-0430
• DOI: 10.5414/CN107684

The aim of the present study was to investigate the interaction of nutritional status, N-terminal probrain-type natriuretic peptide (NT-proBNP) and ventricular remodeling in hemodialysis patients. NT-proBNP was measured by immunoassay. Nutritional status was assessed using the subjective global assessment (SGA) and malnutrition-inflammation score (MIS). Transthoracic echocardiographic examinations were performed on all patients. 44 patients undergoing maintenance hemodialysis were enrolled in this study. Malnourished patients had higher levels of extracellular water (ECW) per kg body weight (BWt) than well-nourished patients and higher levels of NT-proBNP. MIS was positively correlated with left ventricular mass index (LVMI), log NT-proBNP and ECW/BWt, and negatively correlated with fat mass and LV systolic dysfunction. LV systolic dysfunction, LVMI and MIS were independently associated with log NT-proBNP levels. Multiple regression analysis showed that log NT-proBNP, mean arterial pressure and ECW/BWt were independently associated with LVMI. However, MIS did not have an independent relationship to LVMI. Malnutrition in hemodialysis patients is accompanied by volume overload and associated with increased log NT-proBNP levels independent of volume status, and these levels are independently associated with increased LVMI. This suggests a possibility that nutritional status may affect ventricular remodeling in hemodialysis patients.