Comparison of NT-proBNP levels in hemodialysis versus peritoneal dialysis patients

Abstract

Background. Plasma N-terminal fragment of pro brain natriuretic peptide (NT-proBNP) concentration is elevated in cardiovascular diseases such as congestive heart failure, where increased levels of NT-proBNP indicate cardiac dysfunction, hypervolemia, and higher risk of hospitalization and death. These associations apply also to patients with severe impairment of kidney function. Little is known about diferences in plasma level of NT-proBNP in patients receiving hemodialysis (HD) versus those receiving continuous ambulatory peritoneal dialysis (CAPD). Aim. To evaluate differences in plasma NT-proBNP concentration between HD and CAPD patients. Methods. Plasma NT-proBNP concentration was prospectively measured in consecutive patients receiving either HD or CAPD at our hospital center. All other standard clinical parameters were recorded. The correlation between plasma NT-proBNP concentration and the type of dialysis was then examined. Results. We studied 99 consecutive patients on HD (age 62 ± 15 years, 66% male) and 18 consecutive patients on CAPD (age 56 ± 18 years, 67% male). Both groups had similar baseline characteristics including duration of dialysis, left ventricular function and mass, and cardiothoracic ratio. Significantly more patients on HD had abnormal NTproBNP levels compared to patients on CAPD (97% vs 44%; P<0.0001), and this difference remained highly significant when using various NT-proBNP cut off values. A subgroup analysis revealed that the lower NT-proBNP levels of CAPD patients are most pronounced in patients with preserved left ventricular ejection function. As expected, NT-proBNP levels correlated negatively with left ventricular function and positively with cardiothoracic ratio, and this applied to both HD and CAPD groups. Conclusion. The lower concentration of NT-proBNP in patients on CAPD compared to those on HD suggests that CAPD produces lesser hemodynamic stress, especially in patients with preserved left ventricular systolic function. Even though increased NT-proBNP levels have been shown to predict increased morbidity and mortality, further studies are necessary to assess the long term benefit of CAPD compared to HD.

Investigation of optimum N-terminal probrain natriuretic peptide level in patients on maintained hemodialysis

“… 29 A study performed by Ludka et al. 30 showed that the mean absolute level of NT-proBNP in patients on HD was 2281 ± 1710 pmol/L, which was significantly higher than the normal level. In the present study, we established ROC curves to explore the optimal NT-proBNP cutoff value in patients on maintained HD, according to the recommended BP, ultrafiltration/dry weight ratio, and hemoglobin values from the KDIGO and KDOQI guidelines.…”

Comparison of hospitalization cause and risk factors between patients undergoing hemodialysis and peritoneal dialysis

“…Except for the primary cardiovascular diseases, the increase of volume load in the PD group should be fully considered, which was consistent with the findings of previous reports. [11][12][13][14] Consequently, patients should be advised to control the amount of water intake. Diuretics should be appropriately administered to reduce the capacity load, improve the heart function, and reduce the hospitalization rate.…”

Prognostic markers of heart failure in patients undergoing peritoneal dialysis

“…Furthermore, the observed correlation with eGFR was more marked for NT-proBNP than for BNP, and the ratio of NT-proBNP/BNP increased with advancing CKD stage [11]. A high NT-proBNP concentration has been shown to predict morbidity and mortality, and its concentration in patients undergoing CAPD is lower than those undergoing HD [12]. Additionally, NT-proBNP is a significant predictor of cardiovascular congestion, mortality, and adverse cardiovascular outcomes in PD patients [13].…”

“…Cardiac biomarkers, such as BNP and NT-proBNP, are commonly used to diagnose CHF [11]. Pre-proBNP is synthesized in cardiac myocytes in response to ventricular wall stress and stretch, associated with greater cardiac filling pressure [12]. After the removal of a signal peptide in the cytosol, proBNP is released as either NT-proBNP or BNP from myocytes into the circulation [11,13].…”