B-Type Natriuretic Peptide Levels and Cardiac Dysfunction in Children on Peritoneal Dialysis

Abstract

Background Abnormalities in left ventricular (LV) structure and function are prevalent in patients on peritoneal dialysis (PD). The risk of cardiovascular mortality is also 10 – 20 times higher in PD patients than in age- and gender-matched healthy control subjects. Methods Echocardiography was performed annually or every 6 months for children on PD; the frequency was increased if the patient had hypertension or any heart problem. We retrospectively reviewed echocardiographic findings of these children (since February 2005) by chart review. The linear regression analysis of log(B-type natriuretic peptide, BNP) was performed to evaluate the association between serum BNP and cardiac parameters on echocardiography. Results We enrolled 52 patients and evaluated 169 echocardiographic findings in association with serum BNP levels. Systolic blood pressure (adjusted R2 = 0.321), diastolic blood pressure (adjusted R2 = 0.292), LV posterior wall thickness at diastole (0.058), LV posterior wall thickness at systole (0.038), LV internal diameter at diastole (0.177), LV internal diameter at systole (0.132), LV mass index (0.122), thickness of interventricular septum at diastole (0.035), the left atrial (LA) diameter (0.201), LA/aorta diameter ratio (0.113), lateral E/E’ (0.229), and lateral A'/E’ (0.149) showed positive correlation with log(BNP); conversely, LV fractional shortening (FS) (0.065), LV ejection fraction (0.082), right ventricular internal diameter at diastole (0.184), right ventricular fractional shortening (0.754), lateral S’ (0.179), and lateral E’ (0.161) showed negative correlation with log(BNP). Conclusions Routine measurement of serum BNP is recommended in children on PD to evaluate the risk of morphological and functional cardiac problems.

Plasma Brain Natriuretic Peptide Levels in Children with Chronic Kidney Disease and Renal Transplant Recipients: A Single Center Study

“…Similarly, no association between NT-proBNP and LVMI or volume overload has been observed by others in CKD children in pre-dialysis stage [ 43 ]. In contrast, other studies have found a positive correlation between BNP or NT-proBNP levels and LVMI in CKD children as well as in RTRs [ 22 , 23 , 38 , 44 ]. Our study showed that the E/A ratio, a marker of diastolic function, had a significant inverse correlation with BNP.…”

“…The significance was not maintained in multiple linear regression analysis, for the assessment confounding factors. Many studies report a correlation between BNP and NT-proBNP levels and indices of diastolic dysfunction in CKD children [ 12 , 13 , 23 , 44 ]. Moreover, routine measurement of BNP in CKD children on PD, in order to evaluate the risk of functional and morphological cardiac abnormalities, has been recommended [ 44 ].…”

Volume markers in left ventricular diastolic dysfunction and adverse outcomes in peritoneal dialysis patients: a prospective cohort study

“…A previous study showed that the left atrial diameter, E/E′ ratio, and LVEF were significantly lower in overhydrated than normohydrated patients 35 . Moreover, the E/E′ ratio showed a positive correlation with brain natriuretic peptide 36 as well as fluid overload in predialysis CKD patients 37 . The mechanism underlying LVDD is complex.…”