Long-Term Outcomes in Hemodialysis Patients According to Combined NT-proBNP and Galectin-3 Biomarker Profiles

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Background and hypothesis. Mortality in hemodialysis (HD) remains high and cannot be entirely clarified by tradi-tional risk factors. The interplay between arterial stiffness, cardiac remodeling, and biomarker activation, such as galectin-3 and NT-proBNP, may be a potential driver of adverse outcomes in this setting. Combining biomarker profiling with NT-proBNP and galectin-3 may improve risk stratification. Methods. This was an observational study of 173 stable, asymptomatic HD patients, followed for more than 10 years. Patients were classified into four groups based on baseline NT-proBNP and galectin-3 medians (4,234 pg/mL and 28.1 ng/mL, respectively). Pri-mary outcomes were all-cause mortality, major cardiovascular events (MACE), and an exploratory outcome: all-cause mortality stratified by pulse wave velocity (PWV). Results. The overall mortality rate was 76.9% in our cohort: 21.1% died from cardiovascular causes, 21.1% from sepsis, and 22.6% of patients died from other causes. 31.6% of pa-tients were coded as sudden death. High NT-proBNP (Groups 3–4) was associated with the poorest survival (adjusted HR 2.58 and 1.93 vs. Group 1, p< 0.05). Age and PVW were independently associated with higher mortality risk. Each one-year increase in age was associated with a 4% higher risk of death, and each 1m/s increase in PVW corresponded to a 6% increase in mortality risk. MACE occurred in 26.8% and did not differ among biomarker groups. Conclusion. In this long-term HD cohort, biomarker profiles that included high NT-proBNP, pre-dicted all-cause mortality. Raised PWV further augmented risk, underlying the inter-play between cardiac stretch and vascular stiffness.

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