Cardiac natriuretic peptides are related to left ventricular mass and function and predict mortality in dialysis patients

This study was designed to investigate the relationship among brain natriur etic peptide (BNP) and atrial natriuretic peptide (ANP) and left ventricula r mass (LVM), ejection fraction, and LV geometry in a large cohort of dialy sis patients without heart failure (n = 246) and to test the prediction pow er of these peptides for total and cardiovascular mortality. In separate mu ltivariate models of LVM, BNP and ANP were the strongest independent correl ates of the LVM index. In these models, the predictive power of BNP was sli ghtly stronger than that of ANP. Both natriuretic peptides also were the st rongest independent predictors of ejection fraction, and again BNP was a sl ightly better predictor of ejection fraction than ANP. In separate multivar iate Cox models, the relative risk of death was significantly higher in pat ients of the third tertile of the distribution of BNP and ANP than in those of the first tertile (BNP, 7.14 [95% confidence interval (CI), 2.83 to 18. 01, P = 0.00001]; ANP, 4.22 [95% CI, 1.79 to 9.92, P = 0.001]), and a simil ar difference was found for cardiovascular death (BNP, 6.72 [95% CI, 2.44 t o 18.54, P = 0.0002]; ANP, 3.80 [95% CI, 1.44 to 10.03, P = 0.007]). BNP bu t not ANP remained as an independent predictor of death in a Cox's model in cluding LVM and ejection fraction. Cardiac natriuretic peptides are linked independently to LVM and function in dialysis patients and predict overall and cardiovascular mortality. The measurement of the plasma concentration o f BNP and ANP may be useful for risk stratification in these patients.