Association between Intra- and Extra-Cellular Water Ratio Imbalance and Natriuretic Peptides in Patients Undergoing Hemodialysis

Abstract

Natriuretic peptides are associated with malnutrition and volume overload. Over-hydration cannot simply be explained by excess extracellular water in patients undergoing hemodialysis. We assessed the relationship between the extracellular and intracellular water (ECW/ICW) ratio, N-terminal pro-B-type natriuretic peptide (NT-proBNP), human atrial natriuretic peptide (hANP), and echocardiographic findings. Body composition was examined by segmental multi-frequency bioelectrical impedance analysis in 368 patients undergoing maintenance dialysis (261 men and 107 women; mean age, 65 ± 12 years). Patients with higher ECW/ICW ratio quartiles tended to be older, were on dialysis longer, and had higher post-dialysis blood pressure and lower body mass index, ultrafiltration volume, serum albumin, blood urea nitrogen, and creatinine levels (p < 0.05). The ECW/ICW ratio significantly increased with decreasing ICW, but not with ECW. Patients with a higher ECW/ICW ratio and lower percent fat had significantly higher natriuretic peptide levels. After adjusting for covariates, the ECW/ICW ratio remained an independent associated factor for natriuretic peptides (β = 0.34, p < 0.001 for NT-proBNP and β = 0.40, p < 0.001 for hANP) and the left ventricular mass index (β = 0.20, p = 0.002). The ICW-ECW volume imbalance regulated by decreased cell mass may explain the reserve capacity for fluid accumulation in patients undergoing hemodialysis.

Impact of malnutrition in patients with severe heart failure

“…25 Regarding the role of natriuretic peptides, previous studies have identified a potential association between these markers and malnutrition. [26][27][28][29] The association between high concentrations of natriuretic peptides and malnutrition is likely explained by their role as markers of congestion and hence gut oedema, malabsorption, and inflammatory activation. In the context of advanced HF, very-high levels of natriuretic peptides (i.e.…”

“…In particular, bioelectrical impedance analysis is useful to assess body composition, identify malnutrition and perform close and targeted patient monitoring 25 . Regarding the role of natriuretic peptides, previous studies have identified a potential association between these markers and malnutrition 26–29 . The association between high concentrations of natriuretic peptides and malnutrition is likely explained by their role as markers of congestion and hence gut oedema, malabsorption, and inflammatory activation.…”

Associations between N-Terminal Pro-B-Type Natriuretic Peptide, Body Fluid Imbalance and Quality of Life in Patients Undergoing Hemodialysis: A Cross-Sectional Study

“…This is a sub-analysis study of patients who consented to a QOL questionnaire in our previous cross-sectional study. The detailed study design has been published elsewhere [18]. Participants were recruited from four maintenance hemodialysis clinics (Seijinkai Mihama Hospital, Seijinkai Mihama Sakura Clinic, Seijinkai Narita Clinic, and Seijinkai Katori Clinic) between 2019 and 2022.…”

Ratio of Extracellular to Intracellular Water Is Associated with Permanent Catheter Patency Survival in Patients Receiving Maintenance Hemodialysis

“…During the use of a permanent catheter for dialysis initiation and maintenance, patients often experience malfunction and infection of the catheter [7,8]. Several previous studies examined the extracellular-to-total body water (ECW/TBW) and extracellular-to-intracellular water (ECW/ICW) ratios in patients receiving maintenance HD [9][10][11][12][13][14]. However, fewer studies have investigated the association of permanent catheter patency survival with those parameters.…”