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Fluid overload correction and cardiac history influence brain natriuretic peptide evolution in incident haemodialysis
Charles Chazot1, Cyril Vo-Van, Eric Zaoui
1NephroCare, Tassin, France. chchazot@gmail.com
Insights
Plasma brain natriuretic peptide (BNP) levels decrease during hemodialysis (HD) treatment. While initial BNP levels do not predict mortality, later levels do, indicating BNP
Area of Science:
- Cardiology
- Nephrology
- Biomarkers
Background:
- Brain natriuretic peptide (BNP) is a cardiac peptide elevated in conditions of ventricular stretch.
- Increased BNP is linked to higher mortality in end-stage renal disease (ESRD) patients.
- Incident hemodialysis (HD) patients often have fluid overload and cardiac history, potentially elevating BNP.
Purpose of the Study:
- To investigate the evolution of plasma BNP levels in patients initiating HD.
- To examine the relationship between BNP levels, fluid removal, and cardiac history.
- To assess the prognostic value of BNP in incident HD patients.
Main Methods:
- Retrospective analysis of 46 patients surviving at least 6 months on HD.
- Plasma BNP levels measured at HD initiation and during the second quarter (Q2) of treatment.
- Assessment of changes in blood pressure and body weight during HD.
Main Results:
- Initial plasma BNP levels were significantly elevated (1041 ± 1178 pg/mL) and correlated with age, male sex, and cardiac history.
- BNP levels decreased significantly by Q2 (to 631 ± 707 pg/mL) and correlated with systolic blood pressure reduction.
- Initial BNP levels did not predict mortality, but Q2 BNP levels were independently associated with an increased risk of mortality.
Conclusions:
- Plasma BNP levels decrease during the initial months of HD treatment as fluid overload is addressed.
- Initial BNP values may be confounded by fluid overload and cardiac disease, limiting their prognostic utility.
- BNP levels at Q2 are a valuable and independent predictor of mortality in incident HD patients, useful for monitoring dehydration.
Objectives:
Brain natriuretic peptide (BNP) is a cardiac peptide secreted by ventricle myocardial cells under stretch constraint. Increased BNP has been shown associated with increased mortality in end-stage renal disease patients. In patients starting haemodialysis (HD), both fluid overload and cardiac history are frequently present and may be responsible for a high BNP plasma level. We report in this study the evolution of BNP levels in incident HD patients, its relationship with fluid removal and cardiac history as well as its prognostic value.
Methods:
Forty-six patients (female/male: 21/25; 68.6 ± 14.5 years old) surviving at least 6 months after HD treatment onset were retrospectively analysed. Plasma BNP (Chemoluminescent Microparticule ImmunoAssay on i8200 Architect Abbott, Paris, France; normal value < 100 pg/mL) was assessed at HD start and during the second quarter of HD treatment (Q2).
Results:
At dialysis start, the plasma BNP level was 1041 ± 1178 pg/mL (range: 14-4181 pg/mL). It was correlated with age (P = 0.0017) and was significantly higher in males (P = 0.0017) and in patients with cardiac disease history (P = 0.001). The plasma BNP level at baseline was not related to the mortality risk. At Q2, predialysis systolic blood pressure (BP) decreased from 140.5 ± 24.5 to 129.4 ± 20.6 mmHg (P = 0.0001) and the postdialysis body weight by 7.6 ± 8.4% (P < 0.0001). The BNP level decreased to 631 ± 707 pg/mL (P = 0.01) at Q2. Its variation was significantly correlated with systolic BP decrease (P = 0.006). A high BNP level was found associated with an increased risk of mortality.
Conclusions:
Hence, plasma BNP levels decreased during the first months of HD treatment during the dry weight quest. Whereas initial BNP values were not associated with increased mortality risk, the BNP level at Q2 was independently predictive of mortality. Hence, BNP is a useful tool to follow patient dehydration after dialysis start. Initial fluid overload may act as a confounding factor for its value as a prognostic marker because of cardiac disease.
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