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N-terminal pro-brain natriuretic peptide predicts hospitalization for ischemic stroke in Japanese hemodialysis patients

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Abstract

Background

The association between N-terminal pro-brain natriuretic peptide (NT-proBNP) and stroke in Japanese hemodialysis (HD) outpatients is unclear. Therefore, in this study, we investigate whether high NT-proBNP levels are associated with future stroke events in this population.

Methods

This was a multicenter prospective observational study with post hoc analysis. Baseline NT-proBNP levels were measured at the first HD session of the week and classified into tertiles (first tertile: < 2255 pg/mL; second tertile: ≥ 2255 and < 5657 pg/mL; third tertile: ≥ 5657 pg/mL). Overall hospitalization-free survival rates were compared using the Kaplan–Meier method. The association between NT-proBNP level and hospitalization for stroke was assessed using the multivariate Cox proportional hazards models.

Results

During a 5-year follow-up of 1,229 patients, 103 (8.4%) were hospitalized and 23 (1.9%) died from stroke. The hospitalization-free survival rate for ischemic stroke was lowest in the third tertile (P < 0.01). The crude hazard ratio (HR) of hospitalization was higher in the third tertile compared with the first tertile for both ischemic stroke (HR: 3.92; 95% confidence interval [CI] 2.08–7.37; P < 0.01) and hemorrhagic stroke (HR: 3.75; 95% CI 1.35–10.43; P = 0.01). On multivariate Cox hazard analysis, the adjusted HRs for ischemic stroke were higher in the third tertile. The hospitalization-free survival rates for hemorrhagic stroke and the adjusted HRs did not differ significantly.

Conclusions

Elevated NT-proBNP level was associated with hospitalization for ischemic stroke, suggesting that NT-proBNP level is a valid biomarker for predicting hospitalization for ischemic stroke in HD outpatients.

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Acknowledgements

This work was supported by Roche Diagnostics.

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Authors and Affiliations

  1. Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Mai Yamaoka, Mahoko Yoshida, Ayumu Nakashima, Shigehiro Doi & Takao Masaki

  2. Health Service Center, Hiroshima University, Higashihiroshima, Japan

    Mahoko Yoshida

  3. Department of Stem Cell Biology and Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Ayumu Nakashima

  4. Ichiyokai Yokogawa Clinic, Hiroshima, Japan

    Takayuki Naito

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  1. Mai Yamaoka
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  2. Mahoko Yoshida
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  5. Takayuki Naito
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  6. Takao Masaki
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Corresponding author

Correspondence to Mahoko Yoshida.

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Conflict of interest

The founders and staff of Roche Diagnostics had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee at which the studies were conducted, the Ethical Committee for Clinical Research of Hiroshima University (IRB approval number H480), and the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in this study.

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Supplementary Information

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Supplementary file1 (DOCX 23 KB)

10157_2022_2254_MOESM2_ESM.tif

Supplementary file2 ROC curves of pre- and post-HD NT-proBNP for hospitalization for total stroke, ischemic stroke, and hemorrhagic stroke at the 5-year follow-up. Sensitivity and specificity of ROC curves for pre- and post-HD NT-proBNP as predictors of hospitalization for total stroke (A), ischemic stroke (B), and hemorrhagic stroke (C). No significant differences were observed between the AUCs for pre- and post-HD NT-proBNPs (A: P = 0.52, B: P = 0.42, C: P = 0.96). (TIF 1433 KB)

Supplementary file3 (TIF 1423 KB)

Supplementary file4 (TIF 1352 KB)

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Yamaoka, M., Yoshida, M., Nakashima, A. et al. N-terminal pro-brain natriuretic peptide predicts hospitalization for ischemic stroke in Japanese hemodialysis patients. Clin Exp Nephrol 26, 1111–1118 (2022). https://doi.org/10.1007/s10157-022-02254-5

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  • DOI: https://doi.org/10.1007/s10157-022-02254-5

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