Plasma brain natriuretic peptide concentration on assessment of hydration status in hemodialysis patient

Use of Cardiac Biomarkers in End-Stage Renal Disease

“…Given that BNP and NT-pro-BNP are secreted in response to increases in myocardial wall stretch, it is tempting to hypothesize that circulating BNP and NTpro-BNP levels are useful markers of volume status. Indeed, an earlier but very small study of HD patients suggested an association between plasma BNP and extracellular water estimated by bioimpedance 44 ; however, subsequent studies of HD and PD patients that compared the use of BNP and NT-pro-BNP with measurements of extracellular water by bioimpedance or inferior vena cava diameter to assess volume status have so far yielded disappointing results 40,45 and failed to confirm a consistent link between BNP and NT-pro-BNP with extracellular water. A more recent study demonstrated that NT-pro-BNP levels showed small decrements with HD and ultrafiltration; however, the decrements had no correlation with volume removal or interdialytic weight gain.…”

Development and Validation of Bioimpedance Analysis Prediction Equations for Dry Weight in Hemodialysis Patients

“…To address these shortcomings, much research effort has been expended on the search for an objective measurement of fluid status that provides a common standard against which patients may be compared (1,2,6). Blood volume monitoring (2,7), ultrasound assessment of inferior vena cava diameter (2,8), and several biochemical parameters, such as brain or atrial natriuretic peptide (9), have been shown not to give an accurate estimate of DW (1,2). For more than 20 yr, bioelectrical impedance analysis (BIA) has been recognized as a noninvasive and simple technique to measure body hydration status of patients and has gained much attention for the determination of DW in HD patients (10 -13).…”

N-Terminal Pro–B-Type Natriuretic Peptide Variability in Stable Dialysis Patients

“…Ratios ,0.6 indicate a high degree of individuality and imply that NT-proBNP testing is better applied in the dialysis population using a relative-change strategy wherein serial measurements from the same patient are compared with each other rather than comparing single values to a reference interval or a threshold value (36). This finding represents an important departure from the majority of contemporary studies in this area that have sought to derive an absolute NT-proBNP concentration, below which cardiac dysfunction and/or overhydration can be confidently excluded in a manner analogous to which a NT-proBNP concentration ,300 pg/ml is used to exclude acute decompensated heart failure in the nondialysis population (33,(37)(38)(39)(40)(41). Our findings suggest that such a strategy would be inaccurate for predicting cardiovascular risk in the dialysis population, resulting in unacceptably high false negative or false positive rates depending on the threshold value chosen, while also missing the majority of important changes in serial NT-proBNP concentrations measured from an individual dialysis patient (36).…”