The level of the N-terminal pro-B-type natriuretic peptide in patients with different convection volumes during on-line hemodiafiltration

The aim of the study was to estimate the prognostic role of the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in hemodialysis patients with different substitution volumes during on-line hemodiafiltration (HDF). Materials and methods: During the 16 months of the prospective study, 68 patients on maintenance haemodialysis (HD) by the on-line HDF method were under observation. The NT-proBNP serum level was measured for all patients at the time of enrolment. Patients were divided into three groups depending on the substitution volume: <69 l/week; 69-83 l/week and >83 l/week (the mean values of the substitution volume for 16 months were used in statistical analysis for each patient). Results: New cardiovascular events (CVEs) were identified in 25.6% of patients, 47.4% of them were fatal. New CVEs developed more often in patients with CVEs before the start of observation (p<0.05). There was no significant difference in the serum NT-proBNP level and the substitution volume in patients with CVEs and those without them before the start of observation (p>0.05). In patients receiving on-line HDF, there was a lower frequency of CVEs as the quartile of the actual substitution volume increases (p<0.05). In the group with an actual substitution volume of more than 83 l/week, the NT-proBNP level was significantly lower than in the 69-83 l/week group (p<0.05), possibly leading to a more favourable prognosis. The frequency of CVEs in patients who did not reach the substitution volume corrected for body surface area (BSA) is higher than that in those who reach the required substitution volume (p>0.05). Conclusion: The risk of developing new CVEs on maintenance HD is higher in patients with a history of CVEs. The substitution volume of more than 83 l/week may reduce the frequency of CVEs in patients receiving maintenance HD using on-line HDF. There were no differences in NT-proBNP levels in patients with different substitution volume after correction for BSA. The need for accounting the individual BSA when calculating the target volume of substitution with on-line HDF remains unclear.

хроническая болезнь почек, программный гемодиализ, гемодиафильтрация, NT-proBNP, объем замещения, сердечно-сосудистый риск, chronic kidney disease, hemodialysis, hemodiafiltration, NT-proBNP, substitution volume, cardiovascular risk

1. Румянцев А.Ш. Инновации в гемодиализе. Нефрология и диализ. 2019; 21(2): 199-212.

2. Canaud B, Köhler K, Sichart JM, Möller S. Global prevalent use, trends and practices in haemodiafiltration. Nephrol Dial Transplant. 2020;35(3):398-407. DOI:10.1093/ndt/gfz005.

3. Locatelli F, Karaboyas A, Pisoni RL, et al. Mortality risk in patients on hemodiafiltration versus hemodialysis: a 'real-world' comparison from the DOPPS. Nephrol Dial Transplant. 2018;33(4):683-689. doi:10.1093/ndt/gfx277.

4. John T. Daugirdas. Lower cardiovascular mortality with high-volume hemodiafiltration: a cool effect? Nephrology Dialysis Transplantation. 2016;31(6): 853-856. DOI:10.1093/ndt/gfv412.

5. Седов Д.С., Федотов Э.А., Ребров А.П. NT-proBNP и сердечно-сосудистые события у пациентов на программном гемодиализе. Кардиология: новости, мнения, обучение. 2019. 7 (4): 18-23.

6. Kim H, Kim K.H., Ahn S.V., et al. Risk of major cardiovascular events among incident dialysis patients: A Korean national population-based study. Int J Cardiol. 2015;198:95-101. DOI: 10.1016/j.ijcard.2015.06.120.

7. Ассоциация нефрологов Научное общество нефрологов России. Хроническая болезнь почек (Клинические рекомендации) [Электронный ресурс]:2019. URL:http://nonr.ru/wp-content/uploads/2020/01/Clin_guidlines_CKD_24.11_final-3-3.pdf (дата обращения: 01.10.2020).

8. Canaud B, Vienken J, Ash S, Ward RA, Kidney Health Initiative HDF Workgroup. Hemodiafiltration to Address Unmet Medical Needs ESKD Patients. Clinical Journal of the American Society of Nephrology: CJASN. 2018 Sep;13(9):1435-1443. DOI: 10.2215/cjn.12631117.

9. Седов Д. С., Федотов Э. А., Ребров А. П. Диагностическое значение N-терминального фрагмента прогормона мозгового натрийуретического пептида у пациентов на программном гемодиализе. Российский кардиологический журнал.2020;25(1):3621.

10. Chen YH, Fu YC, Wu MJ. NT-ProBNP Predicts Total Mortality, Emergency Department Visits, Hospitalization, Intensive-Care Unit Admission, and Cardiovascular Events in Hemodialysis Patients. J Clin Med. 2019;8(2):238. doi:10.3390/jcm8020238.

11. Шиляева Н.В., Щукин Ю.В., Лимарева Л.В., Данильченко О.П. Биомаркеры миокардиального стресса и фиброза в определении клинических исходов у пациентов с сердечной недостаточностью, перенесших инфаркт миокарда. Российский кардиологический журнал. 2018;(1):32-36.

12. Медведева Е.А., Суркова Е.А., Лимарева Л.В., Щукин Ю.В. Молекулярные биомаркеры в диагностике, стратификации риска и прогнозировании хронической сердечной недостаточности. Российский кардиологический журнал. 2016;(8):86-91.

13. Mostovaya IM, Bots ML, van den Dorpel MA et al. A randomized trial of hemodiafiltration and change in cardiovascular parameters. Clin J Am Soc Nephrol 2014; 9: 520-526.

14. Unruh ML, Larive B, Eggers PW, et al. The effect of frequent hemodialysis on self-reported sleep quality: Frequent Hemodialysis Network Trials. Nephrology, Dialysis, Transplantation: Official Publication of the European Dialysis and Transplant Association - European Renal Association. 2016 Jun;31(6):984-991. DOI: 10.1093/ndt/gfw062.