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Plasma alpha-human atrial natriuretic peptide and volume status in chronic haemodialysis patients
K M Leunissen1, P P Menheere, E C Cheriex
1Department of Internal Medicine, University Hospital Maastricht, The Netherlands.
Insights
Inferior vena cava diameter, a measure of fluid status, strongly correlates with alpha-human atrial natriuretic peptide levels in chronic dialysis patients. Echography can help estimate volume status and guide fluid management.
Area of Science:
- Nephrology
- Cardiology
- Medical Imaging
Background:
- Chronic haemodialysis patients often experience fluid volume disturbances.
- Alpha-human atrial natriuretic peptide (alpha-h-ANP) is a hormone involved in fluid balance.
- Echocardiography can assess volume status through inferior vena cava diameter (VCD) and collapse index (CI).
Purpose of the Study:
- To investigate the relationship between VCD, CI, and alpha-h-ANP concentrations in chronic haemodialysis patients.
- To evaluate the utility of VCD and CI in estimating volume status before and after dialysis.
- To explore the influence of mitral valve insufficiency on alpha-h-ANP levels.
Main Methods:
- Studied 19 chronic haemodialysis patients.
- Measured VCD and CI using echography.
- Assayed alpha-h-ANP concentrations before and after haemodialysis.
Main Results:
- A significant correlation was found between VCD and pre-dialysis alpha-h-ANP (r = 0.78; P < 0.0001).
- Hypervolaemic patients (n=9) had significantly higher pre-dialysis alpha-h-ANP than normo-/hypovolaemic patients (n=10).
- Alpha-h-ANP decreased significantly post-dialysis only in hypervolaemic patients.
Conclusions:
- Vena cava diameter is a valuable tool for estimating volume status in haemodialysis patients.
- Changes in alpha-h-ANP levels during dialysis correlate with fluid removal and VCD.
- Left atrial alpha-h-ANP release may occur in patients with mitral valve insufficiency.
Abstract:
The relationship between inferior vena cava diameter (VCD), collapse-index (CI) determined by echography, and alpha-human atrial natriuretic peptide (alpha-h-ANP) concentrations were studied in 19 chronic haemodialysis patients. A significant correlation was found between VCD and alpha-h-ANP before dialysis (r = 0.78; P less than 0.0001). No such correlation was found between CI, left atrial diameter and left ventricular end-diastolic diameter, and alpha-h-ANP values. In nine patients who according to vena cava indices were hypervolaemic before dialysis (group I), alpha-h-ANP concentrations were significantly greater than in ten normo- or hypovolaemic patients (group II): 392.8 +/- 134.1 pg/ml and 168.0 +/- 62.5 pg/ml respectively. Although the same amount of fluid was ultrafiltrated in both groups, alpha-h-ANP decreased significantly in group I only, whereas in group II the decrease was not significant: 392.8 +/- 134.1 to 185.2 +/- 81.7 (P less than 0.001); 168.0 +/- 62.5 to 130.0 +/- 59 respectively. After achieving normovolaemia alpha-h-ANP concentrations in patients with a mitral valve insufficiency grade I was doubled compared to normovolaemic patients without mitral valve insufficiency, suggesting that alpha-h-ANP release will also occur from the left atrium. In the latter group alpha-h-ANP values were approximately doubled compared to healthy controls. The highly significant correlation between VCD before dialysis and changes in alpha-h-ANP during dialysis with fluid removal underlines the value of vena cava diameter in estimating volume status.