Kidney Week

Abstract: TH-PO170

Pre-Transplant NT-proBNP, Dialysis Duration, and Post-Transplant Mortality in Renal Transplant Recipients

Session Information

• Transplantation: Cardiovascular and Metabolic Diseases
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Yeung, Stanley M.H., University Medical Center Groningen, Groningen, Netherlands

Stanley M.H. Yeung,

• van Londen, Marco, University Medical Center Groningen, Groningen, Netherlands

Marco van Londen,

• Nakshbandi, Uzma, UMCG, Groningen, Netherlands

Uzma Nakshbandi,

• Said, Mohammad Yusof, University Medical Center Groningen, Groningen, Netherlands

Mohammad Yusof Said,

• Eisenga, Michele F., University Medical Center Groningen, Groningen, Netherlands

Michele F. Eisenga,

• Hepkema, Bouke, University Medical Center Groningen, Groningen, Netherlands

Bouke Hepkema,

• Nolte, Ilja M., UMCG, Groningen, Netherlands

Ilja M. Nolte,

• Berger, Stefan P., University of Groningen Medical Center, Groningen, Netherlands

Stefan P. Berger,

• De Borst, Martin H., University Medical Center Groningen, Groningen, Netherlands

Martin H. De Borst,

• Bakker, Stephan J.L., University Medical Center Groningen, Groningen, Netherlands

Stephan J.L. Bakker,

Background

Pre-transplant dialysis duration is associated with increased mortality in renal transplant recipients (RTRs) due to intradialytic volume overload and subsequent progression of left ventricular hypertrophy. As a result, the cardiovascular system could deteriorate into a worse state in potential RTRs. N-terminal pro brain natriuretic peptide (NT-proBNP), a protein released by stretch of ventricular cells caused by volume overload, is a prognostic predictor of mortality in end-stage renal disease patients. The aim is to assess if dialysis duration (DD) is independently associated with mortality in RTRs and if NT-proBNP explains the association between DD with mortality in RTRs.

Methods

648 patients, transplanted (1995-2005) in the University Medical Center Groningen, were prospectively analyzed after exclusion of 225 patients without sera NT-proBNP and 39 patients with graft failure within 1 year after transplantation. Multivariable Cox regression models were used to study the association of DD and NT-proBNP with all-cause mortality. Mediation analysis was performed to evaluate whether the associations between DD and mortality were mediated by NT-proBNP.

Results

In multivariable Cox regression DD was associated with increased risk for post-transplant mortality, independent of potential confounders including age, gender, creatinine, diastolic blood pressure, diabetic nephropathy, donor type, delayed graft function, pre-emptive transplantation and CMV seropositivity (Hazard ratio [HR]: 1.39; 95% confidence interval [CI]: 1.11-1.75; P=0.004). This association weakened after adjustment for NT-proBNP (HR: 1.25; 95% CI: 0.99-1.58; P=0.06). NT-proBNP was independently associated with all-cause mortality in RTRs (HR: 1.46; 95% CI: 1.23-1.74; P=<0.001). In mediation analysis NT-proBNP was found to explain 47.3% of the effect of DD on all-cause mortality in RTRs.

Conclusion

DD is a predictor of mortality in RTRs and variation in NT-proBNP at the time of transplantation to a large extent captures and mediates the effect of DD on mortality risk in RTRs. Future studies are needed to evaluate the potential value of NT-proBNP as check of cardiac patency of patients on the transplantation waiting list.