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Plasma cGMP level as a marker of the hydration state in renal replacement therapy
Insights
Plasma cyclic guanosine 3':5'-monophosphate (cGMP) effectively identifies fluid overload in hemodialysis and CAPD patients. Elevated cGMP levels, particularly above 20 pmol/ml post-dialysis, indicate hyperhydration and can guide fluid management.
Area of Science:
- Nephrology
- Cardiology
- Biochemistry
Background:
- Fluid overload is a common complication in patients undergoing renal replacement therapy (RRT).
- Accurate assessment of hydration status is crucial for managing these patients.
- Current methods for assessing fluid status can be limited in accuracy and clinical utility.
Purpose of the Study:
- To investigate plasma cyclic guanosine 3 : 5 : -monophosphate (cGMP) as a potential biomarker for hyperhydration.
- To evaluate the utility of cGMP in patients undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD).
Main Methods:
- Plasma levels of atrial natriuretic peptide (ANP) and cGMP were measured in 81 HD patients before and after dialysis.
- cGMP levels were assessed in 33 CAPD patients.
- Fluid management was adjusted based on cGMP levels in HD patients.
- Correlation between cGMP levels, hydration status, and cardiac function was analyzed.
Main Results:
- HD patients exhibited significantly elevated ANP and cGMP levels before dialysis compared to post-dialysis.
- A post-dialysis cGMP level above 20 pmol/ml was observed in 23 HD patients, prompting "dry body weight" reduction.
- Weight reduction normalized cGMP levels in most patients; persistently high levels in seven patients were associated with left-sided heart failure.
- CAPD patients with hypervolemia showed significantly elevated plasma cGMP, but not ANP.
Conclusions:
- Plasma cGMP is a reliable indicator of fluid overload in patients on RRT with normal heart function.
- Monitoring plasma cGMP can aid in optimizing fluid management for hemodialysis and CAPD patients.
- Persistently elevated cGMP despite fluid management may suggest underlying cardiac dysfunction.
Abstract:
We investigated, whether plasma cyclic guanosine 3':5'-monophosphate (cGMP) may be suited as a marker of hyperhydration in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). In 81 HD patients the levels of atrial natriuretic peptide (ANP) and cGMP were markedly elevated before HD (ANP: 165 +/- 11.1 pg/ml; cGMP 43.5 +/- 2.2 pmol/ml). Significantly lower values (P < 0.01) were found after HD (ANP: 97 +/- 8.4 pmol/ml; cGMP 19.5 +/- 1.5 pmol/ml). Twenty-three patients had cGMP levels above 20 pmol/ml after HD. Therefore "dry body weight" was reduced in these patients. This resulted in a "normalization" of cGMP values to a postdialytic range below 20 pmol/ml in the majority of patients. All seven patients with persistently high cGMP levels despite weight reduction had left sided heart failure. In 33 CAPD patients ANP was slightly lower than after HD (68 +/- 10.4 pg/ml), and the cGMP level (22.4 +/- 2.3 pmol/ml) was between pre- and postdialytic values in HD. In eight CAPD patients with clinical signs of hypervolemia plasma cGMP, but not ANP, was significantly elevated. We conclude that the plasma cGMP level appears to be a reliable marker for fluid overload in patients on renal replacement therapy with normal heart function.