Natriuretic Peptides as Biomarkers for Congestive States: The Cardiorenal Divergence

Abstract

Congestion represents the primary reason for hospitalization of patients with heart failure and is associated with adverse outcomes. Fluid overload has been shown to be inadequately addressed in a significant subset of these patients in part due to lack of robust, reliable, and readily available biomarkers for objective assessment and monitoring of therapy. Natriuretic peptides have long been used in this setting, often in conjunction with other assessment tools such as imaging studies. Patients presenting with concomitant cardiac and renal dysfunction represent a unique population with regard to congestion in that the interactions between the heart and the kidney can affect the utility and performance of biomarkers of fluid overload. Herein, we provide an overview of the currently available evidence on the utility of natriuretic peptides in these patients and discuss the clinical conundrum associated with their use in the setting of renal dysfunction. We highlight the potential divergence in the role of natriuretic peptides for assessment of volume status in a subset of patients with renal dysfunction who receive renal replacement therapy and call for future research to elucidate the utility of the biomarkers in this setting.

N-Terminal Pro-B-Type Natriuretic Peptide Is a Predictor of Chronic Kidney Disease in an Asian General Population ― The Ohasama Study ―

“…NT-proBNP is enhanced by ventricular wall stretch, volume overload, and venous congestion. 30 , 31 Volume overload or venous congestion triggers increased central venous pressure and decreased cardiac output, renal artery pressure, and endothelial dysfunction, resulting in renal dysfunction. Increased central venous pressure decreases GFR.…”

Need for Objective Assessment of Volume Status in Critically Ill Patients with COVID-19: The Tri-POCUS Approach

“…Interestingly enough, atypical presentations such as heart failure with acute myopericarditis have been reported in patients with COVID-19, which can be associated with hypotension but not volume depletion [13]. Even laboratory parameters commonly associated with volume overload such as an elevated B-type natriuretic peptide level are not reliable owing to their non-specificity [14].…”

NT-proBNP and Cardiovascular Dysfunction in Chronic Liver Disease

“…BNP and NT-proBNP are secreted in plasma in equimolar amounts, being used in the diagnosis of congestive heart failure and in the differentiation of acute dyspnea of cardiac or pulmonary origin [1]. BNP is released at atrial and ventricular levels, and CNP is secreted by the vascular endothelium and has vasodilator properties [1][2][3]. These new biomarkers have been also used for screening of asymptomatic subjects.…”