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Background: The ability of brain natriuretic peptide (BNP) together with other traditional and nontraditional risk factors to predict cardiovascular (CV) mortality in hemodialysis (HD) patients has not been well established. The aim of this prospective study was to determine the predictive cutoff values of baseline measurement of BNP along with the known CV disease risk factors to predict all-cause and CV mortality in HD patients. Methods: BNP concentration before HD was measured in 125 prevalent HD patients (age 53.0 ± 13.5 years, HD vintage 75.2 ± 61.0 months). In addition, several traditional CV risk factors (blood pressure, dyslipidemia, diabetes mellitus, body mass index, left ventricular hypertrophy) and uremia/dialysis-related CV risk factors (anemia, calcium and phosphate impairment, malnutrition, inflammation, ultrafiltration, HD duration, Kt/V) were examined. Results: During the 2-year follow-up, we lost 28 out of 125 patients (22.5%), with CV disease (65.7%) being the main cause of mortality. The cutoff point for BNP, as predictor of the clinical outcome, according to the ROC curve was 1,194 pg/ml for CV mortality with sensitivity and specificity of 63 and 65%, respectively (AUC 0.61 and confidence interval (CI) 95% 0.47-0.75). Kaplan-Meier analysis showed that all-cause (log-rank, p = 0.002) and CV mortality (log-rank, p = 0.001) were the cause of a significantly lower survival in patients with a mean BNP >1,200 pg/ml. The univariate Cox regression analysis found the following factors to be predictors of all-cause mortality: hemoglobin (<110 g/l), phosphorus (>1.78 mmol/l), albumin (<40 g/l), C-reactive protein (CRP ≥10 mg/l), BNP (>1,200 pg/ml) and cardiac ejection fraction (≤55%). The multivariate Cox regression analyses demonstrated that only CRP ≥10 mg/l with a hazard ratio (HR) 6.82 (CI 95% 1.86-24.9, p = 0.004) and BNP >1,200 pg/ml with HR 5.79 (CI 95% 1.58-21.3, p = 0.004) were predictors of all-cause mortality. BNP >1,200 pg/ml with HR 13.52 (CI 95% 1.68-108.9, p = 0.014) was found to be an even stronger predictor of CV mortality than CRP ≥10 mg/l with HR 6.53 (CI 95% 1.35-31.6, p = 0.020). Conclusions: Our study pointed out that BNP >1,200 pg/ml as a marker of cardiac dysfunction and CRP ≥10 mg/l as a marker of inflammation identify HD patients at increased risk of CV mortality. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Although anaemia management has improved in haemodialysis (HD) patients in recent years, many of them still have haemoglobin (Hb) levels below the current recommendations. The consequent anaemia could be one of the links between malnutrition and inflammation, and higher mortality in HD patients. The study objective was to determine the relationship between Hb levels and outcome in patients undergoing HD, accounting for inflammation and malnutrition. We retrospectively analysed a total of 236 patients on HD between January 2003 and December 2005, classified by absence or presence of inflammation and malnutrition (defined as serum albumin levels < 40 g/L and CRP > 8mg/1). Serum levels of Hb, ferritin, creatinine, cholesterol, triglycerides, HDL (high-density lipoprotein cholesterol), LDL (low-density lipoprotein cholesterol), albumin and CRP were measured monthly, fibrinogen was measured every third month. Over the period of three years, 73 out of 236 patients (30%) had died, most from cardiovascular diseases (62%). Presence of inflammation and malnutrition (in 44% of patients) was associated with older age (60.69 ± 12.46 vs. 54.52 ± 12.37, p = 0.0002), lower levels of Hb (99.53 ± 14.97 vs. 111.86 ± 10.38 g/l, p = 0.0000), creatinine (835.88 ± 179.84 vs. 1069.98 ± 821.23 µmol/1, p = 0.0047), albumin (36.58 ± 3.41 vs. 40.32 ± 2.82 g/l, p = 0.0000), cholesterol (4.32 ± 1.04 vs. 4.75 ± 1.09 mmol/1, p = 0.0025) and higher levels of fibrinogen (4.94 ± 1.18 vs. 4.29 ± 0.91g/1, p = 0.0000) and CRP (30.42 ± 29.47 vs. 5.24 ± 4.89 mg/1, p = 0.0000). The Kaplan-Meier analysis showed that, irrespective of the absence or presence of inflammation and malnutrition, the all-cause mortality was higher in patients with Hb < 110 g/1 (Log-Rank, p = 0.00147; p = 0.00222). On the other hand, Kaplan-Meier showed that, irrespective of the absence or presence of anaemia (Hb > 110 g/l and Hb < 110 g/l), the all-cause mortality was higher in patients with the presence of inflammation and malnutrition (Log-Rank, p = 0.00222; p = 0.00263). The Cox proportional hazard analysis, adjusting for age, showed that only lower serum levels of Hb and higher CRP were associated with all-cause mortality (chi-square = 110,306, p = 0.0000). Our findings confirm the association of lib levels < 110 g/L with higher mortality among maintenance HD patients, especially in patients with the presence of inflammation and malnutrition. Further investigation of the relationships among anaemia, inflammation and malnutrition and survival is warranted. [ABSTRACT FROM AUTHOR]

Background: The use of arteriovenous fistula over a central venous catheter in hemodialysis patients is recommended whenever possible. It has become the gold standard among all the available permanent vascular accesses for hemodialysis as it is associated with less complications. The aim of our study was to analyze the type of vascular access in hemodialysis patients in our country, FYR of Macedonia and to see its association with other variables recorded by the National Renal Registry in 2009. Material and methods: Data were collected by 18 hemodialysis centers in the country. A total of 1,457 patients were analyzed. One hundred and ninety one patients were incident, and 164 out of 1,457 died during the year. Except for 9 patients, all the others had data on type of vascular access, as well as data on any vascular access intervention performed during the year. Results: The overall mean age was 58.8 ± 13.1 years. Eighty-nine percent of the non-incident patients (prevalent plus those who died during the year) had arteriovenous fistula, 10.6% central venous catheter and 0.2% vascular graft. When incident to non-incident patients were compared, incident patients were significantly older, had significantly higher mortality and significantly lower percentage of arteriovenous fistula. Patients with arteriovenous fistula had significantly longer dialysis vintage and significantly less deaths compared to those with central venous catheters. Conclusions: The study showed that the number of non-incident hemodialysis patients with arteriovenous fistula in the country was high. The incident hemodialysis patients have high number of central venous catheters as vascular access for hemodialysis and significantly higher mortality compared to non-incident patients. Hippokratia 2014; 18 (3): 209-211. [ABSTRACT FROM AUTHOR]