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Norepinephrine, left ventricular disorders and volume excess in ESRD

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Journal of Nephrology Aims and scope Submit manuscript

Abstract

Background

Sympathetic over-activity is a hallmark of end stage renal disease (ESRD). Left ventricular (LV) disorders and volume overload are pervasive in ESRD and sympathetic over-activity may be a relevant mediator of the cardiovascular (CV) risk by these alterations in this population.

Design

We investigated the relationship between a combined biomarker of LV disorders and volume excess, atrial natriuretic peptide (ANP), and the plasma concentration of nor-epinephrine (NE) in 227 ESRD patients without heart failure at baseline and modelled the risk for incident CV events by these biomarkers over a 3.5 years follow-up.

Results

Plasma NE was strongly and independently related to ANP (β = 0.31, P < 0.001). In a multivariate Cox’s regression analysis, ANP was an independent predictor of these events [HR (1-SD) 1.25, 95 % CI 1.01–1.54]. However, when NE was introduced into the multivariate model, HR by ANP reduced substantially (1.14, 95 % CI 0.91–1.42) and was no longer significant (P = 0.25) while the CV risk signalled by NE was clinically relevant (HR 1.29, 95 % CI 1.05–1.59) and statistically significant (P = 0.02).

Conclusions

In ESRD patients without heart failure, NE is strongly and independently related to ANP. The predictive power of ANP for CV events is largely captured by NE in a statistical model including both biomarkers. These data suggest that sympathetic over-activity may be a relevant mediator of the high risk of CV events triggered by LV disorders and volume excess in this population. However, further mechanistic and intervention studies are needed to prove the nature (causal/non causal) of these findings.

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Acknowledgments

Samar Abd ElHafeez has been granted ERA-EDTA fellowship at CNR-IFC/IBIM Clinical Epidemiology and Physiopathology of Renal Disease and Hypertension of Reggio Calabria, Italy.

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

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

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Authors and Affiliations

  1. Epidemiology Department, High Institute of Public Health, Alexandria University, 165 Elhorreya Avenue, Elhadara, Alexandria, Egypt

    Samar Abd ElHafeez

  2. CNR-IFC/IBIM Clinical Epidemiology and Physiopathology of Renal Disease and Hypertension, Reggio Calabria, Italy

    Giovanni Tripepi, Francesca Mallamaci & Carmine Zoccali

  3. Clinica Medica Università di Catania Ospedale Cannizzaro, Catania, Italy

    Benedetta Stancanelli & Lorenzo Malatino

  4. School of Health Sciences, University of Ioannina, Ioannina, Greece

    Evangelia Dounousi

Authors
  1. Samar Abd ElHafeez
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  2. Giovanni Tripepi
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  3. Benedetta Stancanelli
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  4. Evangelia Dounousi
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  5. Lorenzo Malatino
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  7. Carmine Zoccali
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Correspondence to Samar Abd ElHafeez.

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Abd ElHafeez, S., Tripepi, G., Stancanelli, B. et al. Norepinephrine, left ventricular disorders and volume excess in ESRD. J Nephrol 28, 729–737 (2015). https://doi.org/10.1007/s40620-015-0182-4

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  • DOI: https://doi.org/10.1007/s40620-015-0182-4

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