Clinical value of natriuretic peptides in chronic kidney disease

Abstract

Available online xxxKeywords:B-type natriuretic peptide N-terminal-pro-BNP Heart failure Chronic kidney disease (CKD) Dialysis a b s t r a c t According to several lines of evidence, natriuretic peptides (NP) are the main components of a cardiac-renal axis that operate in clinical conditions of decreased cardiac hemodynamic tolerance to regulate sodium homeostasis, blood pressure and vascular function.Even though it is reasonable to assume that NP may exert a relevant role in the adaptive response to renal mass ablation, evidence gathered so far suggest that this contribution is probably complex and dependent on the type and degree of the functional mass loss.In the last years NP have been increasingly used to diagnose, monitor treatment and define the prognosis of several cardiovascular (CV) diseases. However, in many clinical settings, like chronic kidney disease (CKD), the predictive value of these biomarkers has been questioned.In fact, it is now well established that renal function significantly affects the plasmatic levels of NP and that renal failure is the clinical condition associated with the highest plasmatic levels of these peptides. The complexity of the relation between NP plasmatic levels and CV and renal functions has obvious consequences, as it may limit the predictive value of NP in CV assessment of CKD patients and be a demanding exercise for clinicians involved in the daily management of these patients.This review describes the role of NP in the regulatory response to renal function loss and addresses the main factors involved in the clinical valorization of the peptides in the context of significant renal failure.En esta revisión se describe el papel que desempeñan los PN en la respuesta reguladora ante la pérdida de función renal, y se abordan los principales factores involucrados en el valor clínico que se asigna a los péptidos en el contexto de una insuficiencia renal significativa.

Lung ultrasound for volume status assessment in chronic hemodialysis patients

“…On the other hand, Basso et all found no correlation between BLS and BNP (7). Some authors argue that increased levels of circulating BNP and NT-proBNP in patients on HD and their reduction after dialysis indicate that both BNP and NT-proBNP act as composite markers of hypervolemia, systolic dysfunction and left ventricular hypertrophy (9). It is proven that increased levels of BNP and NT-proBNP are reliable predictors of allcause and cardiovascular mortality (9).…”

“…BNP, a polypeptide secreted by cardiomyocytes in response to their stretching, can be used as a marker for hypervolemia in patients on HD. Elevated BNP levels are registered in 100% of patients on chronic HD, and these levels decline after dialysis (9).This reduction can be explained by increased dialytic clearance of BNP or by better volume control leading to a reduction in left ventricle wall stretching and reduced BNP secretion (10).…”

“…It shows the amount of lung congestion, and is elevated in states of hypervolemia, low oncotic pressure and/or increased lung capillary permeability (10).LUS detects EVLW by registering it as sonographic artifacts called B lines (5). A B line represents an acoustic shadow that forms when an ultrasonic wave meets edematous interlobulus septa in the lungs (9). The exam is performed by placing the probe on 28 predetermined points on the chest and then adding the number of registered B lines, thus getting B line score (BLS) (7).…”

Copeptin level in the early prediction of cardiorenal syndrome in rats

“…BNP was publicly recognized as a clinical diagnostic marker of heart failure. Although BNP was reported to have a certain application value in the early diagnosis of CRS (2,20,21), whether it would accumulate in the body of patients with CRS due to heart failure or the decrease in glomerular filtration rate, as well as its diagnostic value for renal insufficiency, still needed to be further studied (22). CRS is a complex clinical syndrome with various difficulties in its treatment due to the uncertainty of its definition and pathophysiological mechanism.…”

Brain natriuretic peptide and right heart dysfunction after heart transplantation

“…Alternative explanations include the possibility of decreased renal responsiveness attributed to the reduction in functional renal mass, reduced second messenger production, and decreased removal of BNP by the clearance receptor in the renal tissue. Renal function is thus systematically identified as a major confounding factor in the interpretation of elevated BNP and NT‐pro‐BNP and a potential limitation in the current utility of BNP plasmatic level in the CKD population . In fact, renal function probably has influence on circulating BNP values, and 60 mL/min/1.73 m 2 may represent a glomerular filtration rate cutoff value …”