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논문분류	춘계학술대회 초록집
제목	Relative Contribution of Volume Status and Left Ventricular Abnormalities to Elevated Serum N-Terminal Pro-B-type Natriuretic Peptide Level in Incident Dialysis Patients
저자	Kyung Sun Park1, Hyun Chul Chung2, Jong Soo Lee2, Jongha Park2
출판정보	2014; 2014(1):
키워드	말기신부전, 생화학지표, 체수분
초록	Background: N-terminal pro-B type natriuretic peptide (NT-pro-BNP) may be a useful biomarker predicting adverse cardiovascular events. However, the relative contribution of volume status, left ventricular (LV) mass, LV systolic and diastolic dysfunction to elevated circulating NT-pro-BNP level has insufficiently evaluated in end-stage renal disease (ESRD) patients. Methods: A total of 203 patients who commenced maintenance dialysis therapy (2009-2012) and had measurement for serum NT-pro-BNP, were analyzed. Multivariable linear regression model was constructed with age, sex, diabetes, mean arterial pressure (MAP), extracellular water/body weight estimated by bioimpedence analysis (ECW/Wt), ejection fraction (EF), the ratio of early mitral flow velocity to early mitral annulus velocity (E/e’), LV mass index (LVMI), hemoglobin and log C-reactive protein (CRP) as independent variables, and log NT-pro-BNP as dependent variable. Standardized beta coefficient was used to compare the relative contribution of independent variables to NT-pro-BNP level. Results: Patients were 56.1±14.8 years old, 48.3% women, and 54.2% diabetics. Median NT-pro-BNP level was 3630 pg/mL (interquartile range: 960-13731 pg/mL). All of MAP, ECW/Wt, EF, E/e’ and LVMI were significantly correlated with log NT-pro-BNP level in univariate analysis. In multivariable analysis, standardized beta coefficients were -0.303 for EF (p<0.001), 0.269 for ECW/Wt (p<0.001), 0.219 for E/e’ (p<0.001) and 0.154 for LVMI (p=0.008) in order (Table). Table. Summary of Multivariable Regression Model for Log NT-pro-BNP Level Coefficient Std error Beta p-value Age (yr) Male Diabetes MAP (mmHg) ECW/Wt EF (%) E/e’ LVMI (g/m2) Hemoglobin (g/dL) Log CRP (log mg/dL) Constant 0.003 -0.114 -0.011 0.006 6.605 -0.030 0.037 0.004 -0.616 0.208 2.902 0.003 0.087 0.090 0.004 1.318 0.006 0.010 0.001 0.025 0.051 0.667 0.058 -0.068 -0.007 0.089 0.269 -0.303 0.219 0.154 -0.126 0.218 - 0.285 0.193 0.899 0.102 <0.001 <0.001 <0.001 0.008 0.015 <0.001 <0.001 Conclusion: NT-pro-BNP level is influenced by multiple factors including LV structural or functional abnormality as well as volume status in ESRD patients. Although this complexity makes a difficulty in interpretation, NP-pro-BNP may serve as a useful adjunct method to identify cardiac abnormalities and/or volume overload in ESRD patients.
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