NEUROHUMORAL ACTIVITY, HEART FAILURE AND PROGNOSIS IN PATIENTS WITH END STAGE RENAL DISEASE TREATED BY CHRONIC HEMODIALYSIS

Chronic renal failure is frequently accompanied by chronic heart failure. We followed 99 patients with end stage renal failure, treated with hemodialysis (mean duration at baseline 51± 52 weeks) for three years. At baseline, after one, 2 and 3 years echocardiography, Nt-proBNP, BIG endotelin (BE) and other parameters were evaluated.
The incidence of heart failure at baseline was 97%. Six patients had moderate systolic dysfunction (EF < 40%), 37 mild  (EF 40-50%), 83 patients had diastolic dysfunction.  Nt-proBNP was 1870±1450 pg/ml, BE 1,66±0,91 pmol/l, hemoglobin 109±66 mg/l.
Nt-proBNP levels separated patients with systolic dysfunction, restrictive filling, abnormal diastolic filling and normal function (p < 0,001). Nt-proBNP had positive correlation with hemoglobin (p = 0,006), left atrium diameter (p = 0,02) and signs of pulmonary congestion (p = 0,03). Nt-proBNP raised in all patients during the follow up (p < 0,001 for each year). The three year mortality was 50%.  
The sensitivity of NT-proBNP and BE level for the prediction of death was 0,712 resp. 0,824, the specificity 0,642 resp. 0,695, p value 0,04 resp. 0,007. The ROC analysis proved effective cut-off for both parameters – Nt-proBNP > 2000 pg/ml, BIG endothelin > 1,5 pmol/l. Neither Nt-pro BNP nor BE could be incorporated in multivariate model for overall survival, which means that although both parameters significantly influenced overall survival as single risk factors, they were not effective in competition with the other significant predictors.
Overall survival wa influenced  by age (p = 0,007), hemoglobin (p = 0,04), left atrium diameter (p = 0,002), or pulmonary congestion class on chest X ray (p = 0,001), while probability of early risk was associated with BE, C reactive protein, uric acid and hemoglobin. The only intersection of the models was hemoglobin as thoroughly significant predictor.