Midregional proadrenomedullin reflects cardiac dysfunction in haemodialysis patients with cardiovascular disease

Background. Although adrenomedullin is an indicator of cardiac dysfunction in haemodialysis patients, the clinical significance of midregional proadrenomedullin has not been elucidated. Objectives. We evaluated whether midregional proadrenomedullin reflects cardiac dysfunction, systemic inflammation or blood volume in haemodialysis patients. Methods. Plasma midregional proadrenomedullin, C-reactive protein and delta body weight (indicating excessive blood volume), and two-dimensional as well as Doppler echocardiographic variables were measured just before haemodialysis in 70 patients with cardiovascular disease. Results. The median value of midregional proadrenomedullin was 1.93 nmol/l before haemodialysis, and these levels were significantly reduced following haemodialysis. Log [midregional proadrenomedullin] was positively correlated with left ventricular end-systolic volume index, diameter of inferior vena cava, C-reactive protein and delta body weight (r=0.328, r=0.421. r=0.356, r=0.364), and negatively with blood pressure, deceleration time of an early diastolic filling wave, pulmonary venous flow velocity ratio and left ventricular ejection fraction (r=-0.330, r=-0.324, r=-0.479, r=-0.373). Multivariate regression analysis revealed that pulmonary venous flow velocity ratio, diameter of inferior vena cava and C-reactive protein were independently related factors for midregional proadrenomedullin concentration. Conclusion. Plasma midregional proadrenomedullin levels increase in association with cardiac dysfunction, systemic inflammatory status and systemic blood volume in haemodialysis patients with concomitant cardiovascular disease.