Changes in B-type natriuretic peptide levels in hemodialysis and the effect of depressed left ventricular function

Safley, David M.; Awad, Ahmad; Sullivan, Roberta A.; Sandberg, Keisha R.; Mourad, Ibrahim; Boulware, Mark E.; Merhi, William; McCullough, Peter A.

doi:10.1053/j.ackd.2004.11.002

Cited by 36 publications

(25 citation statements)

References 22 publications

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“…Abolished GFR had the greatest influence on the increased peptide concentrations. Although higher peptide concentrations are associated with a worse prognosis, there is agreement in the literature that current decision thresholds for BNP without adjustment for kidney function should not be applied (18,(21)(22)(23)(24). Empirical thresholds have been suggested in mild-to-moderate renal dysfunction, e.g., BNP 300 ng/L instead of 100 ng/L for GFR of 18 -60 mL/min (22 ) and 390 ng/L in HD patients (21 ).…”

Section: Discussionmentioning

confidence: 91%

“…In DCM patients, GFR was estimated according to kidney/Dialysis Outcomes Quality Initiative recommendations using the simplified Modification of Diet in Renal Disease equation (18 ) not applicable to anuric HD patients. In the dialysis patients, body weight, blood pressure, bioelectrical impedance, routine laboratory tests, and natriuretic peptides were recorded before and after a midweek dialysis session.…”

Section: Methodsmentioning

confidence: 99%

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Renal Dysfunction Is a Confounder for Plasma Natriuretic Peptides in Detecting Heart Dysfunction in Uremic and Idiopathic Dilated Cardiomyopathies

Codognotto

Piccoli²,

Zaninotto³

et al. 2007

Clinical Chemistry

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Background:The diagnostic value of natriuretic peptides in uremic cardiomyopathy has not been defined, nor has the effect of a hemodialysis (HD) session on peptides. Methods: We performed an observational study of 100 white adult outpatients in New York Heart Association class I-II, with neither diabetes nor ischemic heart disease, 50 of whom had idiopathic dilated cardiomyopathy (DCM) and 50 of whom had uremic cardiomyopathy and were undergoing HD. We measured plasma N-terminal proB-type natriuretic peptide (NT-proBNP), BNP, and atrial natriuretic peptide (ANP) both before and after a dialysis session. Doppler echocardiograms were evaluated. We performed multiple regression analysis on the logarithm of peptide concentrations using clinical, laboratory, and echocardio-Doppler data as explanatory variables.

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Section: Discussionmentioning

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Renal Dysfunction Is a Confounder for Plasma Natriuretic Peptides in Detecting Heart Dysfunction in Uremic and Idiopathic Dilated Cardiomyopathies

Codognotto

Piccoli²,

Zaninotto³

et al. 2007

Clinical Chemistry

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show abstract

“…Even when measuring NT-proBNP and BNP in dialysate the results are conflicting (38,40). The differences in results were interpreted as probably due to hemoconcentration (40).…”

Section: Introductionmentioning

confidence: 99%

NT-proBNP and Troponin T Levels Differ after Haemodialysis with a Low versus High Flux Membrane

et al. 2015

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Background Brain natriuretic peptide (BNP), N-terminal-proBNP (NT-proBNP), and high sensitive cardiac troponin T (TnT) are markers that are elevated in chronic kidney disease and correlate with increased risk of mortality. Data are conflicting on the effect of biomarker levels by hemodialysis (HD). Our aim was to clarify to what extent HD with low-flux (LF) versus high-flux (HF) membranes affects the plasma levels of BNP, NT-proBNP, and TnT. Methods and Materials 31 HD patients were included in a crossover design, randomized to start dialysis with a LF-HD or HF-HD dialyzer. Each patient was his/her own control. The dialyses included in the study were the first treatments of two consecutive weeks with each mode of dialysis. Patients normally on hemodiafiltration (HDF) also performed a HDF the third week. Values after HD were corrected for extent of ultrafiltration. Results During LF-HD the biomarkers NT-proBNP and TnT increased (15 versus 6%, P≤.001) while there was a slight decrease in BNP (P<.05). During HF-HD the NT-proBNP, BNP and TnT levels decreased (P≤.01 for all). During HDF all three markers decreased (P<.01 for all). The rise in TnT during LF-HD correlated with dialysis vintage (months on HD, r = .407, P = .026), Kt/V-urea (r = .383, P = .037), HD time in hours/treatment (r = .447, P = .013) and inversely with residual urinary output (r = -.495, P = .005). The baseline levels of BNP and NT-proBNP correlated with blood pressure. Conclusions Cardiac biomarkers increase slightly during LF-HD. A HF-HD eliminates the biomarkers and can mask increases caused by, e.g., myocardial infarction.

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“…Table 3 lists conditions other than heart failure than can cause an increase in BNP and NT-proBNP (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Renal dysfunction is a confounder for cTnT and cTnI as well as BNP and NT-proBNP.…”

Section: Overview Of Other Etiologies a Background And Scopementioning

confidence: 99%

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Use of Cardiac Troponin and B-Type Natriuretic Peptide or N-Terminal proB-Type Natriuretic Peptide for Etiologies Other than Acute Coronary Syndromes and Heart Failure

et al. 2007

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Changes in B-type natriuretic peptide levels in hemodialysis and the effect of depressed left ventricular function

Cited by 36 publications

References 22 publications

Renal Dysfunction Is a Confounder for Plasma Natriuretic Peptides in Detecting Heart Dysfunction in Uremic and Idiopathic Dilated Cardiomyopathies

Renal Dysfunction Is a Confounder for Plasma Natriuretic Peptides in Detecting Heart Dysfunction in Uremic and Idiopathic Dilated Cardiomyopathies

NT-proBNP and Troponin T Levels Differ after Haemodialysis with a Low versus High Flux Membrane

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Use of Cardiac Troponin and B-Type Natriuretic Peptide or N-Terminal proB-Type Natriuretic Peptide for Etiologies Other than Acute Coronary Syndromes and Heart Failure

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