It is well known that plasma
atrial natriuretic peptide (
ANP) is an
indicator of extracellular fluid volume expansion and that plasma
ANP is considered to be a marker for setting the proper dry weight of HD patients. Although the plasma
ANP is a prognostic predictor of
cardiac death, the prognostic role of
ANP in HD patients has yet to be elucidated. In this study, we investigated the prognostic role of
ANP in HD patients.
METHODS: Plasma
ANP concentrations were measured in 105 HD patients after HD. Multiple regression analysis was performed to determine the major factors causing increased plasma
ANP concentrations. Cardiac mortality was monitored for 24 months after baseline analysis, and the prognostic role of
ANP was examined by Cox proportional hazards regression analysis.
RESULTS: Multiple regression analysis showed that
cardiovascular disease (CD) and age were independent factors for elevated
ANP (R2 = 0.298, p < 0.0001). During a 24-month follow-up period,
cardiac death occurred in 11 patients. Kaplan- Meier survival estimates of patients from varying plasma
ANP levels (<50 and >50 pg/ml) differed between the two groups (p < 0.0001). The group with the higher
ANP level (>50 pg/ml) had the lower survival. When compared with patients with
ANP <50, the hazard ratios for
cardiac death of patients with
ANP of >50 pg/ml were 32.0 (95% confidence interval (CI) 4.1 to 252.4). Univariate Cox proportional hazards model showed that
ANP, left ventricular ejection fraction (LVEF), LVMI, age,
serum albumin and
C-reactive protein (CRP) were significantly associated with the risk of cardiac mortality. By stepwise multivariate Cox proportional hazards analysis, only
ANP, LVMI and CRP remained powerful independent predictors of
cardiac death. The relative risk ratios were 3.483 (95% CI 1.640-7.397) for ln
ANP, 1.023 (1.008-1.038) for LVMI, and 1.379 (1.115-1.705) for CRP.
CONCLUSION: High plasma
ANP level of post-HD were strongly associated with CD and age. Post-HD
ANP level may be a reliable parameter for assessing the risk for
cardiac death in HD patients by providing prognostic information independent of other variables previously reported.