Clinical value of natriuretic peptides in chronic kidney disease

Abstract

According to several lines of evidence, natriuretic peptides (NP) are the main components of a cardiac-renal axis that operate in clinical conditions of decreased cardiac hemodynamic tolerance to regulate sodium homeostasis, blood pressure and vascular function. Even though it is reasonable to assume that NP may exert a relevant role in the adaptive response to renal mass ablation, evidence gathered so far suggest that this contribution is probably complex and dependent on the type and degree of the functional mass loss. In the last years NP have been increasingly used to diagnose, monitor treatment and define the prognosis of several cardiovascular (CV) diseases. However, in many clinical settings, like chronic kidney disease (CKD), the predictive value of these biomarkers has been questioned. In fact, it is now well established that renal function significantly affects the plasmatic levels of NP and that renal failure is the clinical condition associated with the highest plasmatic levels of these peptides. The complexity of the relation between NP plasmatic levels and CV and renal functions has obvious consequences, as it may limit the predictive value of NP in CV assessment of CKD patients and be a demanding exercise for clinicians involved in the daily management of these patients. This review describes the role of NP in the regulatory response to renal function loss and addresses the main factors involved in the clinical valorization of the peptides in the context of significant renal failure.

The multifaceted role of natriuretic peptides in metabolic syndrome

“…In contrast to normal (non-diabetic) controls, ANP in type 2 diabetes does not rise in response to feeding, clearly showing the significance of natriuretic peptide signaling cascades in renal pathophysiology [104]. BNP and pro-BNP play an important role in the renal function, which affects the plasmatic levels of these natriuretic peptides and this may limit their utility as hemodynamic biomarkers in renal failure [105]. Hence, all these studies prove the significance of natriuretic peptides and shows that there exists a direct connection in the function between cardiac and renal system.…”

B‐type natriuretic peptide is a useful biomarker for the estimation of volume overload in children with hypertension on peritoneal dialysis

“…Substantial increase of BNP was observed in patients with ESRD . BNP was also strongly associated with left ventricular end‐diastolic wall stress in heart failure in ESRD patients . BNP may be a useful marker of volume status in patients on dialsysis .…”

“…B‐type natriuretic peptide (BNP) is synthesized and released from the ventricular myocytes in response to increased ventricular wall stress . Plasma BNP level is determined by the synthesis and release rate, and removal by enzymatic degradation and receptor‐mediated (mainly natriuretic peptide receptor‐C) endocytosis followed by a lysosomal degradation . Substantial increase of BNP was observed in patients with ESRD .…”

“…Plasma BNP level is determined by the synthesis and release rate, and removal by enzymatic degradation and receptor‐mediated (mainly natriuretic peptide receptor‐C) endocytosis followed by a lysosomal degradation . Substantial increase of BNP was observed in patients with ESRD . BNP was also strongly associated with left ventricular end‐diastolic wall stress in heart failure in ESRD patients .…”

“…BNP was also strongly associated with left ventricular end‐diastolic wall stress in heart failure in ESRD patients . BNP may be a useful marker of volume status in patients on dialsysis . However, interpretation of elevated BNP in ESRD population has been confusing because deterioration of the renal function had been systemically identified as a significant confounding factor .…”