Exploring Determinants of NT-ProBNP in Moroccan Patients Undergoing Chronic Hemodialysis

Background: N-terminal pro-brain natriuretic peptide (NT-proBNP) is a crucial biomarker for myocardial stress, commonly elevated in patients undergoing chronic hemodialysis due to reduced renal clearance and associated cardiac modifications. However, beyond fluid overload, systemic inflammation and malnutrition may also play a key role in regulating NT-proBNP levels. Objective: This study aims to identify the determinants influencing NT-proBNP levels in Moroccan patients undergoing chronic hemodialysis, with a specific focus on natremia, metabolic, inflammatory, and nutritional biomarkers. Methods: A cross-sectional observational study was conducted between January and June 2024, including 101 chronic hemodialysis patients at CHU Mohammed VI of Marrakech. Patients were divided into two groups based on NT-proBNP levels: Group 1 (<450 pg/mL) and Group 2 (≥450 pg/mL). Clinical and biological parameters were analyzed, including CRP, albumin, creatinine, and dialysis duration. Statistical analyses were performed using SPSS 25.0, including Student’s t-test, Chi-square test, ANOVA, and multiple linear regression. Results: Patients with higher NT-proBNP levels had significantly increased CRP levels (p < 0.001), indicating a stronger inflammatory response. They also exhibited lower albumin levels (p = 0.002) and reduced creatinine levels (p = 0.01), suggesting poor nutritional status and muscle mass loss. A longer dialysis duration was observed in the high NT-proBNP group (p = 0.04). However, natremia levels did not significantly differ between groups (p = 0.32). Conclusion: NT-proBNP elevation in chronic hemodialysis patients is primarily influenced by inflammation and malnutrition, rather than fluid overload or sodium imbalances. These findings suggest that NT-proBNP should be interpreted as a multifactorial biomarker rather than solely a marker of volume overload. Assessing NT-proBNP alongside CRP and albumin levels could improve risk stratification and patient management