The Association of Mid-Regional Pro-Adrenomedullin and Mid-Regional Pro-Atrial Natriuretic Peptide with Mortality in an Incident Dialysis Cohort
The Association of Mid-Regional Pro-Adrenomedullin and Mid-Regional Pro-Atrial Natriuretic Peptide with Mortality in an Incident Dialysis Cohort
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DOI：
10.1371/journal.pone.0017803
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发表时间：
2011-03-07
期刊：
影响因子：
3.7
通讯作者：
Kronenberg, Florian
中科院分区：
文献类型：
--
作者：
Gouya, Ghazaleh;Sturm, Gisela;Kronenberg, Florian
在一般人群中，高水平的血浆肽中间区域肾上腺髓质素原（MR-proADM）和中间区域心房利钠肽原（MR-proANP）与临床结局相关。慢性肾病患者的数据很少。因此，我们在INVOR研究的201例事件透析患者中研究了MR-proANP和MR-proADM水平与全因和心血管（CV）死亡率、CV事件和外周动脉疾病的相关性，这些患者前瞻性随访长达7年以上。总体死亡率为43%，其中43%是由于CV事件。基线MR-proANP和MR-proADM均与高风险的全因（HR = 1.44，p = 0.001和HR = 1.32，p = 0.002）和CV死亡率（HR = 1.75，p < 0.001和HR = 1.41，p = 0.007）校正年龄、性别、既往CV事件后，糖尿病和时间依赖型肾脏替代治疗。然后，我们将患者分为高风险（两种肽都在上三分位数中）、中等风险（两种肽中只有一种在上三分位数中）和低风险（没有在上三分位数中）。尽管中危组和高危组的人口统计学、临床和实验室变量相似，但两个参数均在上三分位数的患者，全因（HR = 2.87，p < 0.001）和CV死亡率（HR = 3.58，p = 0.001）风险增加3倍。总之，在事件透析患者中，MR-proANP和MR-proADM显示与全因死亡率和CV死亡率相关，当两个参数均在上三分位数时风险最高。
High levels of the plasma peptides mid-regional pro-adrenomedullin (MR-proADM) and mid-regional pro-atrial natriuretic peptide (MR-proANP) are associated with clinical outcomes in the general population. Data in patients with chronic kidney disease are sparse. We therefore investigated the association of MR-proANP and MR-proADM levels with all-cause and cardiovascular (CV) mortality, CV events and peripheral arterial disease in 201 incident dialysis patients of the INVOR-Study prospectively followed for a period of up to more than 7 years. The overall mortality rate was 43%, thereof 43% due to CV events. Both baseline MR-proANP and MR-proADM were associated with higher risk of all-cause (HR = 1.44, p = 0.001 and HR = 1.32, p = 0.002, respectively) and CV mortality (HR = 1.75, p < 0.001 and HR = 1.41, p = 0.007, respectively) after adjustment for age, sex, previous CV events, diabetes mellitus and time-dependent type of renal replacement therapy. We then stratified patients in high risk (both peptides in the upper tertile), intermediate risk (only one of the two peptides in the upper tertile) and low risk (none in the upper tertile). Although demographic, clinical and laboratory variables were similar among the intermediate and high risk group, to be with both parameters in the upper tertile was associated with a 3-fold higher risk for all-cause (HR = 2.87, p < 0.001) and CV mortality (HR = 3.58, p = 0.001). In summary, among incident dialysis patients MR-proANP and MR-proADM were shown to be associated with all-cause and CV mortality, with the highest risk when both parameters were in the upper tertiles.