These findings support plasma BNP level as a reliable marker of LV overload, even in nondialysis patients with CRF. Also, a high BNP level (> or =150 pg/mL) may have powerful predictive potential for heart failure in these patients.

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Our findings indicate that masked hypertension is associated with advanced target organ damage in treated hypertensive patients, comparable to that in cases of sustained hypertension.

BACKGROUND: Plasma B-type natriuretic peptide (BNP) is a diagnostic and prognostic marker in heart failure (HF). Although renal function is reported as an important clinical determinant, precise evaluations of the relationships of renal function with hemodynamic factors in determining BNP have not been performed. Therefore, we evaluated the association of plasma BNP concentrations with LV end-diastolic wall stress (EDWS) in a broad range of HF patients including those with chronic kidney disease (CKD) and endstage renal disease (ESRD). METHODS:In 156 consecutive HF patients including those with CKD and ESRD, we measured plasma BNP and performed echocardiography and cardiac catheterization. LV EDWS was calculated as a crucial hemodynamic determinant of BNP. RESULTS:Plasma BNP concentrations increased progressively with decreasing renal function across the groups (P Ͻ 0.01) and were correlated with LV EDWS (r ϭ 0.47) in the HF patients overall. This relationship was also present when patients were subdivided into systolic and diastolic HF (P Ͻ 0.01). In multivariable analysis, higher EDWS was associated with increased BNP concentration independently of renal dysfunction (P Ͻ 0.01). Anemia, systolic HF, and decreased BMI also contributed to increased BNP concentrations. CONCLUSIONS:These results suggest that LV EDWS is a strong determinant of BNP even in patients with CKD and ESRD. Anemia, obesity, and HF type (systolic or diastolic) should also be considered in interpreting plasma BNP concentrations in HF patients. These findings may contribute to the clinical management of HF patients, especially those complicated with CKD and ESRD. © 2009 American Association for Clinical ChemistryChronic kidney disease (CKD) 5 is frequently associated with a progressive decrease in glomerular filtration rate (GFR), which leads to end-stage renal disease (ESRD) (1 ). The number of patients with CKD as well as ESRD is increasing markedly worldwide (2, 3 ). Several investigators have documented that patients with CKD are at higher risk of cardiovascular disease than the general population, and show a higher rate of cardiovascular mortality (4-6 ). In particular, ESRD patients have a 500-fold greater rate of cardiovascular mortality than age-matched controls with normal renal function (7 ). Heart failure (HF) is also an increasingly prevalent condition and the leading cause of death among cardiovascular diseases in patients with CKD and ESRD (8 ). There may be some interaction between heart disease and kidney disease, and HF patients who have CKD or ESRD show a worse prognosis (9, 10 ). Thus, early diagnosis and aggressive management of HF are needed in patients with CKD and ESRD. Conversely, early recognition and management of CKD are also necessary in patients with HF.B-type natriuretic peptide (BNP) is synthesized in the ventricular myocardium in response to ventricular stretching and wall stress (11 ). BNP and N-terminal pro-BNP (NT-proBNP), which are associated with the severity of HF and left ventricular (LV) function, are...

Background. Since the predictive value of orthostatic hypotension (OH) at the introductory phase of haemodialysis (HD) is unknown, we examined the association between OH and all-cause death in patients who started HD between 1987 and 2001. Methods. More than three consecutive blood pressure measurements before HD treatments (pre-HD BP) were made on each of 304 patients who had recently been started on HD and were in a stable condition. OH was defined as a drop in systolic BP of >20 mmHg or in diastolic BP of >10 mmHg after standing. Results. Of 304 patients, 42% had OH. OH was significantly associated with pre-HD supine systolic BP; its severity was significantly associated with a past history of cerebrovascular disease and pre-HD supine systolic BP. During a mean follow-up of 4.0±3.0 years (range 0.1-13.2 years), 136 deaths were recorded. A multivariate Cox proportional hazards model analysis demonstrated that OH and a past history of cerebrovascular disease were independent predictors of all-cause death. The comparison by Kaplan-Meier analysis of the overall survival of patients with and without OH was significant. Conclusions. Our findings validate OH at the introductory phase of HD as a novel independent predictor of all-cause mortality among HD patients.