Association of N-Terminal Pro-brain Natriuretic Peptide With Volume Status and Cardiac Function in Hemodialysis Patients

Abstract

Introduction: N-terminal-pro-brain natriuretic peptide (NT-pro BNP) is secreted by cardiomyocytes in cases of cardiac structure disorder and volume overload. However, the relationship between NT-pro BNP level and body fluid status in dialysis patients with reduced cardiac ejection function (EF) is uncertain. Therefore, we aimed to investigate this relationship.Methods: We enrolled patients who had been receiving hemodialysis for >3 months. Blood sample, transthoracic echocardiographic, and bioimpedance spectroscopy measurements were performed during a midweek non-dialysis day. The predictive value of NT-pro BNP in hemodialysis patients with volume overload was analyzed.Results: A total of 129 hemodialysis patients (74 men and 55 women; mean age: 59.4 ± 13.0 years) were recruited. The average hemodialysis duration was 55.5 (23.9–93.4) months, the NT-pro BNP level was 4992 (2,033–15,807) pg/mL, and the value of overhydration was 2.68 ± 0.19 (−1.9 to 12.2) L. The NT-pro BNP level was independently correlated with overhydration in both the LVEF ≥ 60% (β = 0.236, P = 0.044) and LVEF <60% (β = 0.516, P = 0.032) groups, even after adjustments for potentially confounding variables. In receiver operating characteristic curves of NT-pro BNP for predicting volume overload, the area under the curve was 0.783 [95% CI (0.688–0.879), P < 0.001) and 0.788 [95% CI (0.586–0.989), P < 0.001] in the LVEF ≥ 60% and LVEF < 60% groups, respectively.Conclusions: NT-pro BNP is a predictive factor for volume overload in hemodialysis patients with or without EF declines.

Prediction of Heart Function and Volume Status in End-Stage Kidney Disease Patients through N-Terminal Pro-Brain Natriuretic Peptide

“…Moreover, we planned to analyze the correlation by measuring NT-proBNP and BIS-OH in dry weight (less overhydration status) after HD. In the previous study [11], because BIS and NT-proBNP were measured on a midweek non-dialysis day, the volume status of the patients was overestimated compared to our study, and the variability of OH was large (OH: 2.68 [−1.9-12.2] vs. 0.4 [−0.7-1.5]). Although NT-proBNP decreased after dialysis, enrolled patients used the same dialyzer and dialysis machine.…”

“…Because volume overload in ESKD patients can lead to systemic hypertension and HF [ 9 ], it is important to properly evaluate volume status. NT-proBNP could be helpful for monitoring excess fluid volume and dry weight [ 10 , 11 , 12 ]. However, kidney function has an inverse correlation with NT-proBNP level [ 13 , 14 ].…”

“…One study demonstrated an association between NT-proBNP and volume overload in patients with hemodialysis but not cardiac dysfunction [ 10 ]. In another study [ 11 ], although NT-proBNP showed a correlation with both volume status and cardiac function, there was a limitation in that volume overload was overestimated by measuring bioimpedance spectroscopy and NT-proBNP on a midweek non-dialysis day.…”

Multifrequency bioimpedance by spectroscopy vs. routine methods in the management of hydration status in peritoneal dialysis patients: A randomized control trial

“…These authors found significant associations between OH/AEC and higher NT-proBNP levels. Likewise, Wang et al ( 37 ) evaluated 129 HD patients and reported an association between NT-proBNP levels and hyperhydration assessed by BCM, concluding that the BIS is a reliable marker of volume status.…”

Relation between carotid intimal medial thickness and left ventricular mass and left ventricular mass indices in maintenance hemodialysis patients

“…Interestingly, Wakabayashi et al found that cardiac function can get better by controlling dry body weight even in HD patients with high AVF blood flow [35]. A recent study by Wang et al on 129 HD patients documented the predictive value of NT-pro-BNP in the assessment of volume overload in hemodialysis patients with or without EF declines [36]. Baki et al found that combined elevation of BNP level and decreased IVC collapsibility index were sensitive markers for subclinical volume overload detection in CKD patients [37].…”