NT-pro-BNP as marker for cardiac strain that may be caused by high-output arteriovenous shunting in a haemodialysis patient. A case report

Abstract

Background An arteriovenous fistula (AVF) is the first choice when considering access for haemodialysis (HD). When a forearm AVF fails an upper arm AVF is a frequent subsequent dialysis access option. The latter may cause cardiac strain. NT-pro-B-type natriuretic peptide (NT-NT-proBNP) is a marker used to estimate volume overload and cardiac strain. This case report shows the benefit of using longitudinal individual follow-up of pre-dialysis NT-proBNP in clinical practice to detect changes in cardiac condition that may be due to high-output AVF. Case presentation An 18 years old patient performed HD via an upper arm AVF before he was admitted to our unit. NT-proBNP was above the upper detection level of 70,000 ng/L. Echocardiography revealed a left-ventricular cardiac insufficiency. Interdialytic weight gain (IDWG) was above 5%. He was instructed to lower fluid intake and IDWG towards 2%. Four months later NT-proBNP surpassed 70,000 ng/L again. Flow in the brachial artery was at 3034 ml/min. Reconstructive surgery of the AVF did not reduce flow and NT-proBNP in the long run. Clinically, he worsened to NYHA class III-IV. It was decided to close the upper arm AVF and to replace it with a lower arm AVF leading to a reduced artery flow of 1344 mL/min. The clinical condition successively recovered and NT-proBNP decreased to 7000 ng/L. Conclusions Pre-dialysis NT-proBNP should be considered as a suitable routine marker for cardiac strain such as caused by high-output AVF besides variables such as IDWG. Brachial artery flow besides AVF flow measurement is helpful.

Long-term cardiac effect of sacubitril-valsartan in hemodialysis patients with a reduced ejection fraction after aortic valve replacement for aortic stenosis: a case report with literature review

“…However, cardiac stress induced by high flow in arteriovenous fistulas can present tremendously high NT-proBNP levels [24]. Figure 4 shows changes in NT-proBNP levels before and after arteriovenous fistula reconstruction in a 78-year-old woman who had been treated with hemodialysis for 7 years.…”

Wearable and implantable artificial kidney devices for end‐stage kidney disease treatment: Current status and review

“…To route blood through the extracorporeal circuit (ECC) and enable hemodialysis, the procedure requires wellfunctioning vascular access. 21,22 Lower arm arteriovenous fistulas and grafts are preferred to tunneled catheters. Tunneled catheters are a portal for infection into the endovascular system.…”

The prognostic role of finger pressures and access flows in hemodialysis patients

“…Echocardiography supporting a decision of Q a -reduction was used in 25 articles describing 413 patients (41%). 18,19,25,26,28,32,34,41,42,43,45,47,48,49,50,56,61,66,70,72,74,75,78,80 stated although left ventricular mass index (LVMi) decreased following surgery. 25,70 Changes in serum Brain Natriuretic Protein (BNP) and Atrial Natriuretic Protein (ANP), biomarkers linked to cardiac failure, 82,83 were measured in one study and decreased greatly following Q a -reduction.…”

“…25,70 Changes in serum Brain Natriuretic Protein (BNP) and Atrial Natriuretic Protein (ANP), biomarkers linked to cardiac failure, 82,83 were measured in one study and decreased greatly following Q a -reduction. 45 a reducing techni ues…”

“…Fourteen articles reported on banding without an intraoperative tool (n=105 patients, 64% male, mean age 61 ; table 2). 34,35,36,37,38,39,40,41,42,43,44,45,46,47 RA-AVF (…”