Background and objective: Pre-transplant dialysis duration (DD) is associated with increased mortality in renal transplant recipients (RTRs) due to accelerated atherosclerosis, intradialytic volume overload and subsequent progression of left ventricular hypertrophy. As a result, the cardiovascular system could deteriorate into a worse state in potential RTRs. N-terminal pro brain natriuretic peptide (NT-proBNP), a protein released by stretch of ventricular cells caused by volume overload, is a prognostic predictor of mortality in end-stage renal disease patients. The aim is to assess if DD is independently associated with mortality in RTRs and if NT-proBNP explains the association between DD with mortality in RTRs.

Material and methods: 648 patients, transplanted (1995-2005) in the University Medical Center Groningen, were prospectively analyzed after exclusion of 225 patients without sera NT-proBNP and 39 patients with graft failure within 1 year after transplantation. Multivariable Cox regression models were used to study the associations of DD and NT-proBNP with all-cause mortality. Mediation analysis was performed to evaluate whether the associations between DD and mortality were mediated by NT-proBNP.

Results: In multivariable Cox regression DD was associated with increased risk for post-transplant mortality, independent of potential confounders including age, gender, creatinine, diastolic blood pressure, diabetic nephropathy, donor type, delayed graft function, pre-emptive transplantation and CMV seropositivity (Hazard ratio [HR]: 1.39; 95% confidence interval [CI]: 1.11-1.75; P=0.004). This association weakened after adjustment for NT-proBNP (HR: 1.25; 95% CI: 0.99-1.58; P=0.06). NT-proBNP was independently associated with all-cause mortality in RTRs (HR: 1.46; 95% CI: 1.23-1.74; P=<0.001). In mediation analysis NT-proBNP was found to explain 47.3% of the effect of DD on all-cause mortality in RTRs.

Conclusion: DD is a predictor of mortality in RTRs and variation in NT-proBNP at the time of transplantation to a large extent captures and mediates the effect of DD on mortality risk in RTRs. Future studies are needed to evaluate the potential value of NT-proBNP as check of cardiac patency of patients on the transplantation waiting list.

CITATION INFORMATION: Yeung M., Van Londen M., Nakshbandi U., Said Y., Eisenga M., Hepkema B., Nolte M., Berger S., De Borst M., Bakker S. Pre-Transplant Duration of Dialysis, N-Terminal Pro-Brain Natriuretic Peptide and Post-Transplant Mortality in Renal Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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