Inflammation, overhydration and cardiac biomarkers in haemodialysis patients: a longitudinal study

• Published in: Nephrology, dialysis, transplantation Vol. 25; no. 1; pp. 243 - 248
• Main Authors: Jacobs, Leo H., van de Kerkhof, Jos J., Mingels, Alma M., Passos, Valéria Lima, Kleijnen, Vincent W., Mazairac, Albert H., van der Sande, Frank M., Wodzig, Will K., Konings, Constantijn J., Leunissen, Karel M., van Dieijen-Visser, Marja P., Kooman, Jeroen P.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-01-2010
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; bioimpedance; Biological and medical sciences; Biomarkers - blood; Body Composition - physiology; Body Fluids - physiology; C-Reactive Protein - metabolism; Cross-Sectional Studies; Emergency and intensive care: renal failure. Dialysis management; Female; Follow-Up Studies; haemodialysis; Humans; Inflammation - physiopathology; Intensive care medicine; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - therapy; Longitudinal Studies; Male; Malnutrition - physiopathology; Medical sciences; Middle Aged; Natriuretic Peptide, Brain - blood; natriuretic peptides; Natriuretic Peptides - blood; overhydration; Peptide Fragments - blood; Regression Analysis; Renal Dialysis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; troponin; Troponin T - blood; bioimpedance; haemodialysis; natriuretic peptides; overhydration; troponin; Kidney disease; Human; Extrarenal dialysis; Troponin; Urinary system disease; Hemodialysis; Renal failure; Inflammation
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfp417

Background. Inflammation, overhydration and elevated cardiac biomarkers are related to outcome in haemodialysis (HD) patients. Here, we explored the relationship between the body composition (BC), inflammation and cardiac biomarker concentrations in HD patients longitudinally. Methods. A total of 44 HD patients were followed for 6 months. BC was assessed by multifrequency bioimpedance (BIA). Serum concentrations of cardiac troponin T (cTnT), high-sensitive C-reactive protein (hsCRP), brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) were assessed at 2 monthly intervals. The longitudinal data analysis was conducted with a marginal model. Results. During the follow-up, the parameters describing the BC were highly predictive of both BNP and NT-proBNP and independent of gender, time, hsCRP and cTnT concentrations. The intracellular water (ICW)/body weight (BW) ratio (reflecting malnutrition) exerted a negative effect, whereas the extracellular water (ECW)/BW ratio (reflecting overhydration) had a positive effect on BNP and NT-proBNP concentrations. HsCRP and cTnT concentrations were significantly associated with each other. Furthermore, NT-proBNP concentrations were predictive of cTnT and hsCRP concentrations. Conclusions. In the present study, we find a significant relation between BIA-derived BC parameters and natriuretic peptide concentrations. This relationship was independent of the cardiac history of the patient and suggests that the natriuretic peptide levels are to some degree modifiable by changing a patient's fluid distribution. Moreover, cTnT, BNP, NT-proBNP and hsCRP were significantly related, showing a complex relation between overhydration, malnutrition, inflammation and cardiac biomarkers in dialysis patients.