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Titolo	Inflammation, overhydration and cardiac biomarkers in haemodialysis patients: a longitudinal study
Autore	Leo H. Jacobs1,∗, Jos J. van de Kerkhof 2,∗, Alma M. Mingels1, Val´eria Lima Passos3, Vincent W. Kleijnen1, Albert H. Mazairac2, Frank M. van der Sande2, Will K. Wodzig1, Constantijn J. Konings4, Karel M. Leunissen2, Marja P. van Dieijen-Visser1 and Jeroen P. Kooman2 - 1Department of Clinical Chemistry, 2Division of Nephrology, Department of Internal Medicine, University Hospital Maastricht, 3Department of Methodology and Statistics, Maastricht University, Maastricht and 4Department of Internal Medicine, Catharina Hospital, Eindhoven, the Netherlands
Referenza	Nephrol Dial Transplant 2009; doi: 10.1093/ndt/gfp417
Contenuto	Background. Inflammation, overhydration and elevated cardiac biomarkers are related to outcome in haemodialysis (HD) patients. Here, we explored the relationship between the body composition (BC), inflammation and cardiac biomarker concentrations in HD patients longitudinally. Methods. A total of 44 HD patients were followed for 6 months. BC was assessed by multifrequency bioimpedance (BIA). Serum concentrations of cardiac troponin T (cTnT), high-sensitive C-reactive protein (hsCRP), brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) were assessed at 2 monthly intervals. The longitudinal data analysis was conducted with a marginal model. Results. During the follow-up, the parameters describing the BC were highly predictive of both BNP and NT-proBNP and independent of gender, time, hsCRP and cTnT concentrations. The intracellular water (ICW)/body weight (BW) ratio (reflecting malnutrition) exerted a negative effect, whereas the extracellular water (ECW)/BW ratio (reflecting overhydration) had a positive effect on BNP and NTproBNP concentrations. HsCRP and cTnT concentrations were significantly associated with each other. Furthermore, NT-proBNP concentrations were predictive of cTnT and hsCRP concentrations. Conclusions. In the present study, we find a significant relation between BIA-derived BC parameters and natriuretic peptide concentrations. This relationship was independent of the cardiac history of the patient and suggests that the natriuretic peptide levels are to some degree modifiable by changing a patient?s fluid distribution. Moreover, cTnT, BNP, NT-proBNP and hsCRP were significantly related, showing a complex relation between overhydration, malnutrition, inflammation and cardiac biomarkers in dialysis patients.
Data	04.09.2009

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