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Brain natriuretic peptide in hemodialysis patients: predictive value for hemodynamic change during hemodialysis and
Tetsutaro Matayoshi1, Toako Kato, Hajime Nakahama
1Division of Hypertension and Nephrology, National Cardiovascular Center, Suita, Japan.
Insights
Brain natriuretic peptide (BNP) levels do not predict blood pressure drops in hemodialysis patients. However, elevated BNP effectively indicates cardiac dysfunction in these individuals.
Area of Science:
- Nephrology
- Cardiology
- Biomarkers
Background:
- Brain natriuretic peptide (BNP) is a key cardiac marker, but its interpretation is complicated in hemodialysis (HD) patients due to frequent elevations unrelated to heart disease.
- Understanding BNP's role in HD patients is crucial for accurate clinical assessment.
Purpose of the Study:
- To investigate the predictive value of BNP for blood pressure (BP) fall during HD sessions.
- To assess BNP's utility as an indicator of cardiac function in patients undergoing maintenance HD.
Main Methods:
- A cohort of 205 uremic patients (160 males, 45 females; mean age 66.5 years) on maintenance HD were studied.
- BNP levels, clinical data, and echocardiographic findings were collected. 111 patients had a history of ischemic heart disease.
Main Results:
- BNP levels ranged from 6 to 16,097 pg/ml (median 831 pg/ml).
- BNP did not correlate with the degree of BP fall during HD. Factors like ischemic heart disease, ultrafiltration rate, pre-HD systolic BP, and serum sodium predicted BP changes.
- A BNP level >785 pg/ml accurately predicted left ventricular dysfunction (sensitivity 73%, specificity 65%).
Conclusions:
- BNP levels are not reliable predictors of intradialytic hypotension in uremic patients.
- Despite limitations in predicting BP fall, BNP remains a valuable biomarker for assessing cardiac function in patients on hemodialysis.
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.
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