Combined role of echocardiographic parameters and NT-proBNP in predicting mortality in maintenance hemodialysis patients

Background and purpose: Echocardiographic features and levels of N-terminal of pro-brain natriuretic peptide (NT-proBNP) have been associated with adverse outcomes in patients on maintained hemodialysis (HD). This study aims to investigate whether combining NT-proBNP with echocardiographic parameters enhances the accuracy of mortality risk prediction in this patient population. Methods: A cohort of 199 patients undergoing maintenance HD (45.7% female; mean age, 56.4 years) was analyzed. Hazard ratios (HRs) were calculated using Cox regression models to estimate the risk of all-cause mortality related to a 1-standard deviation increase in echocardiographic parameters. The performance of the models was assessed by the area under the receiver operating characteristic curve. Results: During a median follow-up of 31.7 months (interquartile range [IQR]: 20.1–42.5 months), 37 patients (18.6%) died. Multivariable-adjusted analysis showed that larger left atrial diameter indexed to body surface area (LADi; HR: 1.85; 95% confidence interval [CI]: 1.30–2.62, P < 0.001) and higher E / e ’ ratio (HR: 1.49; 95% CI: 1.05–2.12; P = 0.025) were significantly associated with increased mortality risk. Elevated log-transformed NT-proBNP levels were also correlated with a significantly higher risk of death (HR: 2.35; 95% CI: 1.33–4.17; P = 0.003). In addition, patients with both elevated NT-proBNP levels and either a larger LADi or higher E / e ’ ratios exhibited the largest mortality risk (P ≤ 0.006). Incorporating E / e ’ or LADi with NT-proBNP into the base model significantly improved the area under the receiver operating characteristic curve (AUC) from 0.79 to 0.84 (P = 0.034) and 0.86 (P = 0.022), respectively. Conclusions: The combination of NT-proBNP levels with echocardiographic parameters, particularly LADi and E / e ’ ratio, significantly enhances all-cause mortality risk prediction in maintenance HD patients. These findings suggest that integrating NT-proBNP with echocardiographic parameters could improve risk stratification in HD patients.