Review Article

N-terminal Pro-B-Type Natriuretic Peptide and Malnutrition in Patients on Hemodialysis

Table 1

Summary of studies on relationships between NT-proBNP and protein energy wasting in maintenance hemodialysis.

AuthorsCountryNumber of HD subjectsStudy design
Assessment of malnutrition
Men/women
Age (years)
NT-proBNP levels

Guo et al. [13]Sweden222Cross-sectional study and longitudinal study
SGA
120/102
59 (47–72) y (median (IQR))
Values (median (IQR)): 11,609 (4,581–35,000) with wasting signs (SGA > 1) 5,671 (1,909–17,141) pg/ml in those without
Negatively associated with nutrition markers, including serum albumin, IGF-1, handgrip strength, serum creatinine, and body weight
Higher values (>9,761 pg/ml) associated with PEW (SGA > 1)
Independently predicted PEW
Nonsurvival had a poorer nutritional status

Bednarek-Skublewska et al. [11]Poland97Cross-sectional study
Indices of nutritional status and BIA
57/40
20–92 y (range)
Values (range): 403–35,000 pg/ml
Negatively correlated with BMI, albumin, and transferrin
Elevated in patients with intensive catabolism

Lee et al. [15]Korea44Cross-sectional study
SGA and MIS
21/23
53.9 ± 9.2 y (mean ± SD)
Values (median (IQR)): 4,342 (1,582–22,304) pg/ml in well-nourished 24,807 (11,435–44,127) pg/ml in malnourished
Negatively correlated with fat mass
Positively correlated with MIS
Elevated in those with malnutrition

Snaedal et al. [17]Sweden211Longitudinal study
SGA
55/156
66 (51–74) y (median (IQR))
Values (median (IQR)): 8,946 (2,909–26,571) pg/mL 12,932 (5,658–35,001) pg/mL with PEW (SGA > 1) 6,092 (2,248–17,670) pg/mL without PEW
Associated with malnutrition (SGA > 1)
Changes in NT-proBNP associated with change in nutritional status
Worse nutritional status was significantly related to increased variability

Schwermer et al. [16]Poland
Sweden
321Longitudinal study
Indices of nutritional status and BIA
206/115
65 ± 21 y (mean ± SD)
Values: (mean ± SD): 6,098 ± 19,659
NT-proBNP correlated negatively with practically all nutritional indices
Cohort divided into NT-proBNP quartiles (with lowest values in Q1)
BMI and fat tissue index decreased across NT-proBNP quartiles; highest albumin level was present in Q1 Lowest total cholesterol level in Q4

Ikeda et al. [14]Japan238Longitudinal study
SGA
149/89
64 ± 13 y (mean ± SD)
Values (median (range)): 2,910 (465–78,400) pg/ml
Associated with muscle loss in malnourished HD patients
Independently predicted the decreased change of LBM and the index of muscle loss
Higher NT-proBNP levels: Decreased levels of creatinine, creatinine index as well as %CGR, lower total fat mass, and LBM and higher frequency of malnutrition

Ducros et al. [12]Guadeloupe (France)207Cross-sectional study
ISRNM nomenclature for PEW
112/95
64 ± 13 y (mean ± SD)
Values (range): 125–33,144 pg/ml (median (IQR)): 6,243 (1833–18,721) pg/mL with PEW 2,132 (1,100–5,200) pg/mL without PEW
Elevated in those with BMI ≤23 Kg/m2), albumin ≤38 g/L, creatinine,
≤818 μmol/L, nPCR ≤0.8 g/kg/d) and PEW (at least 3 among the 4 parameters)
Negatively correlated with BMI and nPCR
Increased with the increasing of the PEW marker number
Values ≥6243 pg/mL independently associated with PEW

BIA: bioimpedance analysis. %CGR: percentage creatinine generation rate. MIS: malnutrition-inflammation score. IQR: interquartile range. ISRNM: International Society of Renal Nutrition and Metabolism. PEW: protein energy wasting. SD: standard deviation. SGA; subjective global assessment.