Kidney Week

Abstract: SA-PO369

Higher NT-ProBNP Levels and the Risk of Intradialytic Hypotension at Hemodialysis Initiation

Session Information

• Hemodialysis and Frequent Dialysis: CV and Risk Prediction
  November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Curtis, Katherine, Brigham and Women's Hospital, Boston, Massachusetts, United States

Katherine Curtis,

• Waikar, Sushrut S., Boston University School of Medicine, Boston, Massachusetts, United States

Sushrut S. Waikar,

• McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States

Finnian R. McCausland,

Group or Team Name

• Mc Causland Lab

Background

Elevated N-terminal pro B-type natriuretic peptide (NT-proBNP) accompanies cardiac dysfunction and hypervolemia and is a potent predictor of adverse outcomes in patients initiating hemodialysis (HD). These patients often experience intradialytic hypotension (IDH), which may partially reflect cardiac dysfunction, but the association of NT-proBNP with IDH is not clear.

Methods

We performed a post-hoc analysis of a double-blind, placebo-controlled, randomized trial that tested mannitol vs. placebo in 52 patients initiating HD (NCT01520207). Pre-HD NT-proBNP was measured in samples obtained prior to the 1^st and 3^rd sessions (n=87). Mixed-effects models (adjusting for randomized treatment, sex, Black race, age, diabetes, heart failure (HF), catheter use, pre-HD systolic blood pressure (SBP), pre-HD weight, ultrafiltration (UF) volume, sodium, bicarbonate, serum urea nitrogen, phosphate, albumin, and hemoglobin) were fit to examine the association of NT-proBNP with intradialytic SBP decline (pre-HD minus nadir SBP). Additionally, mixed-effects Poisson regressions were fit to determine the association with IDH (≥20 mmHg decline in SBP from pre-HD SBP).

Results

Mean age of patients was 55±16 years and 32% had baseline HF. The median pre-HD NT-proBNP across all sessions was 5498 [2011, 14790] pg/mL. A total of 26 sessions were complicated by IDH. In adjusted models, each unit higher log-NT-proBNP was associated with 5.8mmHg less decline in intra-dialytic SBP (95%CI -9.2 to -2.5, P=0.001). Higher pre-HD NT-proBNP was associated with a 54% lower risk of IDH per log unit NT-proBNP (IRR 0.46, 95%CI 0.23-0.92, P=0.03). There was no evidence for effect modification by randomized treatment (P-interaction=0.68).

Conclusion

In patients initiating HD, higher pre-HD NT-proBNP is associated with less decline in intradialytic SBP and lower risk of developing IDH. Future studies should investigate if higher pre-HD NT-proBNP levels can help identify hypervolemic patients who might tolerate more aggressive UF.

Baseline SBP characteristics across NT-proBNP tertiles

Funding

• NIDDK Support