Modern peptide biomarkers and echocardiography in cardiac healthy haemodialysis patients

Abstract

BackgroundIn this prospective study, we aimed to assess the haemodynamic changes before and after haemodialysis (HD) in cardiac healthy subjects on chronic HD by imaging methods and endocrine markers of fluid balance.MethodsMid-regional pro-atrial natriuretic peptide (MR-proANP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), vasopressin (AVP) and copeptin (CT-proAVP), metanephrines and normetanephrines, renin and aldosterone, standard transthoracic echocardiography and diameter of vena cava inferior (VCID) were performed in 20 patients with end stage renal disease (CKD5D) before and after HD and were stratified in residual excretion (RE, less or more 0.5 l) and ultrafiltration rate (UF, less or more 2 l).ResultsCopeptin was significantly higher in patients before HD. Copeptin was inversely correlated with haemodialysis treatment adequacy (KT/v), RE and UF, but was not significantly influenced by age, gender and body mass index (BMI). MR-proANP was significantly reduced by haemodialysis by 27% and was inversely correlated with KT/v, but there was a significant influence by UF, RE, age, gender and BMI. NT-proBNP was significantly higher in patients before HD and was not influenced by RE and UF. Renin, aldosterone, metanephrines and normetanephrines did not demonstrate significant differences. Echocardiographic parameters and VCID were significantly correlated with RE, UF and copeptin.ConclusionModern biomarkers will provide cardiovascular risk assessment, but elimination (UF), RE and other factors may influence the serum concentrations, e.g. in patients with renal impairment. The interpretation will be limited by altered reference ranges, and will be restricted to individual courses combined with clinical and echocardiographic data.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-017-0589-3) contains supplementary material, which is available to authorized users.

Dialysate copeptin and peritoneal transport in incident peritoneal dialysis patients

“…In our study, plasma copeptin correlated with renal Kt/V but not with peritoneal Kt/V, suggesting that kidneys play a major role in the elimination of copeptin. Similar to Rasche et al [26], we did not find a significant association of copeptin with age or gender.…”

“…On the other hand, Rasche et al showed that plasma copeptin levels, which were approximately 11-fold higher in hemodialyzed patients compared to normal population, decrease during the hemodialysis (HD) session. The relative reduction of copeptin during HD correlated inversely with the Kt/V ratio, indicating that copeptin might be eliminated by HD [26].…”