Brain Natriuretic Peptide in Hemodialysis Patients: Predictive Value for Hemodynamic Change during Hemodialysis and Cardiac Function

Abstract

Background: Though brain natriuretic peptide (BNP) is widely used as a clinical marker of cardiac function, there is considerable confusion in the interpretation of its value in hemodialysis (HD) patients whose BNPs are often elevated without cardiac diseases. The aim of the present study is to examine the predictive value of BNP for blood pressure (BP) fall during HD and cardiac function. Methods: Subjects consisted of 205 (160 males, 45 females; age 66.5 ± 10.5 years) consecutive uremic patients requiring maintenance HD who were admitted to our hospital during 2001–2004. One hundred and eleven cases had a history of ischemic heart disease. We measured BNP in all cases and collected clinical data including age, sex, duration of HD, blood examination and echocardiography. Results: BNP of all 205 cases ranged from 6 to 16,097 pg/ml (median 831). During HD, the average BP change was –24.5 ± 20.5 mm Hg, and 111 cases showed a systolic BP reduction >20 mm Hg. BNP did not predict the degree of BP fall. After adjusting confounding factors, the presence of ischemic heart disease, ultrafiltration rate, systolic BP before HD and serum sodium concentration showed a significant correlation with BP change (t = –2.84, –2.76, –4.68 and 2.90; p = 0.005, <0.01, <0.0001 and <0.005, respectively). In relation to echocardiographic indices, BNP >785 pg/ml could predict left ventricular dysfunction (fractional shortening of the left ventricle <30%, sensitivity 73%, specificity 65%). Conclusion: The level of BNP could not predict BP fall during HD. However, BNP is a good indicator of cardiac function even in uremic patients.

Effects of Angiotensin II Type 1 Receptor Blocker on Blood Pressure Variability and Cardiovascular Remodeling in Hypertensive Patients on Chronic Peritoneal Dialysis

“…The results of this study revealed that plasma levels of the natriuretic peptides, ANP and BNP, were decreased concomitantly with the decreases in BP variability in the ARB groups. The plasma natriuretic levels are reported to be a good indicator of cardiac function and a sensitive marker of diastolic heart failure even in ESRD patients [35]. The results of this study also showed that baPWV was improved more efficiently concomitantly with the decreases in BP variability in the ARB groups.…”

NT-proBNP Concentration and Early Cardiac Dysfunction in Patients Receiving Dialysis: A Prospective Cohort Study

“…Our finding of an association between NT-proBNP and GLS or higher NT-proBNP levels predicting worsening GLS had not been reported in patients with ESKD on dialysis in the literature, and it is in keeping with previous investigations in non-ESKD studies [13, 19]. In another study of 205 hemodialysis patients, Matayoshi et al [20] reported that serum BNP concentrations >785 pg/mL predicted LV dysfunction defined by fractional shortening <30% with a sensitivity of 73% and a specificity of 65%. GLS was chosen as the primary outcome as there was evidence suggesting that it is more sensitive than LVEF in detecting cardiac systolic dysfunction and provides incremental prognostic value to LVEF [13, 19].…”

Are levels of brain natriuretic peptides useful to determine volume status in dialysis patients?

“…Many studies have explored the cross‐sectional relationship between NPs as markers of volume overload, in particular bioimpedance analysis or inferior vena cava ultrasound. In our review of 15 pertinent studies, B‐type NPs were significantly associated with measures of hypervolemia (measured by a clinical score, bioimpedance analysis, or inferior vena cava ultrasound) in nine studies (7–15), whereas no relationship was found in 10 (7–9,15–21). Of these 15 studies, four had contrasting findings depending on the outcome measure for volume assessment (7–9,15).…”