Prohormone brain natriuretic peptide (proBNP), BNP and N-terminal-proBNP circulating levels in chronic hemodialysis patients. Correlation with ventricular function, fluid removal and effect of hemodiafiltration

Bargnoux, Anne-Sophie; Klouche, Kada; Fareh, Jeanette; Barazer, I.; Villard-Saussine, Sylvie; Dupuy, Anne‐Marie; Leray‐Moragues, Hélène; Giuliani, Isabelle; Canaud, Bernard; Cristol, Jean‐Paul

doi:10.1515/cclm.2008.192

Cited by 49 publications

(49 citation statements)

References 21 publications

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“…These findings contrast with those of a longitudinal cohort study demonstrating that baseline hypertension at dialysis inception and residual hypertension at 1-year post-dialysis commencement were associated with a significantly increased risk of mortality without any survival disadvantage associated with low blood pressure (45), and those of a prospective cohort study of 692 haemodialysis patients which reported that a mean arterial blood pressure > 110 mmHg was associated with an increased risk of all-cause and cardiovascular death after adjusting for demographic factors and co-morbid conditions (46). Finally, a recent meta-analysis of 8 randomised controlled trials of antihypertensive therapy in dialysis found significant reductions in the risks of fatal and nonfatal cardiovascular events and all-cause mortality in actively treated patients compared with controls supporting the hypothesis that hypertension portends an adverse prognosis in the dialysis population(47).…”

Section: Hypertensioncontrasting

confidence: 99%

“…BNP and NT-proBNP have a number of proven clinical applications in the general population, including improving the accuracy of clinical assessment for diagnosing cardiac failure in patients presenting with dyspnoea (44,45) and estimating prognosis in patients with an established diagnosis of cardiac failure (46). Over the last decade, 9 randomised controlled trials have examined the role of BNP / NT-proBNP monitoring in guiding heart failure therapy compared to specialist care alone.…”

Section: Biochemistry and Established Clinical Applications Of The B-mentioning

confidence: 99%

“…Guidelines have either provided no guidance on the magnitude of change in serial troponins (43,44) or have based their guidance on the analytic performance of troponin assays rather than clinical studies, wherein a 20% magnitude of change has been recommended based on the fact that such a delta equates to 3 standard deviations of the troponin assay's analytic variation (45).…”

Section: Interpretation Of Troponin Measurements From Dialysis Patienmentioning

confidence: 99%

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Cardiac biomarkers for the diagnosis and monitoring of cardiovascular disease in the dialysis population

Fahim¹

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Dialysis patients have a 10-50 fold increased risk of cardiac death compared to the general population. Key factors underpinning this heightened risk are fluid overload-induced cardiomyopathy and ischaemic heart disease. Progress in modifying these outcomes has been hampered by our inability to assess patients' fluid status and cardiac risk in an accurate and dynamic manner. The overarching aim of this thesis is to advance our understanding of the roles of two cardiac biomarkers, the amino terminal fragment of pro-B-type natriuretic peptide (NTproBNP) and high sensitivity cardiac troponin-T (hs-cTnT), in diagnosing and monitoring cardiovascular disease in the dialysis population.Two multi-centre, prospective cohort studies were performed. The aim of the first study was to estimate the biological variation of NT-proBNP and plasma hs-cTnT in 55 prevalent haemodialysis and peritoneal-dialysis patients, and to use these estimates to derive the critical difference between serial measurements needed to detect a clinically significant change with 90% confidence. Patients were reviewed weekly for 4 consecutive weeks then monthly for a further 4 months. Assessments were conducted at the same dialysis-cycle time point and entailed clinical review, bioimpedance spectroscopy, electrocardiography, hs-cTnT and NT-proBNP testing. Patients were excluded if they underwent a change in cardiac medication, dialysis prescription, ischaemic symptomatology, extracellular volume >1L, new arrhythmia or hospitalisation between visits. 137 weekly and 114 monthly NT-proBNP and hs-cTnT measurements from 42 stable patients were analysed. Between-person(CVG) and within-person(CVI) coefficients of variation were estimated using nested analysis of variance. For weekly measurements CVG, CVI, and the critical difference were 153%, 27%, and -46% and +84% respectively for NT-proBNP, and 83%, 7.9%, and -25% and +33% respectively for hs-cTnT. For monthly measurements CVG, CVI, and the critical difference were 148%, 35%, and -54% and +119% respectively for NT-proBNP, and 79%, 12.6%, 2.4% and -37% to +58% respectively for hs-cTnT. The CVI:CVG ratios for weekly and monthly measurements were 0.18 and 0.24 respectively for NT-proBNP, and 0.10 and 0.16 respectively for hs-cTnT. CVG was not significantly different by dialysis modality, hydration status, history of ischaemic heart disease, NT-proBNP or hs-cTnT concentration, severity of left ventricular hypertrophy, systolic or diastolic dysfunction. Thus, serial NT-proBNP levels need to double or halve and hs-cTnT levels need to increase by at least 20-34% or fall by 17-25% to confidently exclude change due to analytical & biological variation alone. The low CVI:CVG implies the best strategy for applying 3 these biomarkers in dialysis is relative change monitoring after a baseline estimate rather than comparing results to reference intervals.The second study performed was a longitudinal cohort study of 103 prevalent haemodialysis and peritoneal dialysis patients, of whom 78 patients also participate...

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Section: Hypertensioncontrasting

confidence: 99%

Section: Biochemistry and Established Clinical Applications Of The B-mentioning

confidence: 99%

Section: Interpretation Of Troponin Measurements From Dialysis Patienmentioning

confidence: 99%

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Cardiac biomarkers for the diagnosis and monitoring of cardiovascular disease in the dialysis population

Fahim¹

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“…The BNP and NT-proBNP have been investigated in other volume-overloaded states. A study of 31 dialysis patients without evidence of cardiac failure found that BNP and NT-proBNP values decreased with hemodialysis [13]. This drop did not correlate with the post hemodialysis fluid removal or weight decrease [13].…”

Section: Natriuretic Peptidesmentioning

confidence: 99%

“…A study of 31 dialysis patients without evidence of cardiac failure found that BNP and NT-proBNP values decreased with hemodialysis [13]. This drop did not correlate with the post hemodialysis fluid removal or weight decrease [13]. In another small study, Giglioli et al, assessed 15 patients with congestive heart failure undergoing slow continuous ultrafiltration.…”

Section: Natriuretic Peptidesmentioning

confidence: 99%

Fluid-Volume Assessment in the Investigation of Acute Heart Failure

Tuy

Than

2013

Curr Emerg Hosp Med Rep

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Heart failure is a syndrome whereby cardiac function is incapable of providing for the body's circulatory demands, resulting in hemodynamic and volumetric aberrations. Acute heart failure (AHF) is the condition where signs and symptoms of heart failure are present that require urgent intervention. In AHF impaired cardiac function progresses to hemodynamic congestion and eventually develops into a fluid overloaded state. These patients will typically present acutely for medical assistance, with signs and symptoms of fluid overload (dyspnea, paroxysmal nocturnal dyspnea, orthopnea, edema, etc.) and/or hypoperfusion (malaise, altered mental status, decreased urine output). In patients with AHF, volume assessment is a crucial step in the initial diagnosis.

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Relationship of Brain Natriuretic Peptide Concentrations to Left Ventricular Function and Adverse Outcomes in Children With End-Stage Renal Disease Undergoing Hemodialysis

et al. 2011

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B-type natriuretic peptide (BNP) is a biomarker of cardiovascular disease that is common in adults with chronic kidney disease (CKD). However, in children with CKD, the range and predictive power of BNP concentrations are not known. We aimed to determine the effect of HD on BNP, as well as the prognostic impact of BNP, in end-stage renal disease (ESRD) children undergoing hemodialysis (HD). Thirty-five children with chronic renal failure (16 boys age 12.1 ± 3.7 years) on maintenance HD were included. BNP level was measured, and Doppler echocardiography was performed 30 min before (pre-HD BNP) and 30 min after (post-HD BNP) HD in each patient. An adverse event was defined as all-cause death and heart failure hospitalization. The median pre-HD BNP, the post-HD BNP, and the change in BNP were, respectively, 240 pg/ml (72 to 3346), 318 pg/ml (79 to 3788), and 9 pg/ml (-442 to 1889). Pre-HD BNP concentration was negatively correlated with left ventricular (LV) ejection fraction (r = -0.41, P = 0.018). During a mean follow-up of 39 ± 14 months, 6 patients died, and 3 were hospitalized for heart failure. Using univariate analysis, BNP before and after HD as well as Doppler tissue imaging velocities had a strong graded relationship with adverse events. Cox proportional hazards model demonstrated that pre-HD body weight (P = 0.008), pre-HD BNP (P = 0.011), and post-HD BNP (P = 0.038) remained independent predictors of adverse outcome. Even in case of ESRD, BNP still strongly correlated with LV systolic and diastolic dysfunction and was associated with mortality in HD children.

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Prohormone brain natriuretic peptide (proBNP), BNP and N-terminal-proBNP circulating levels in chronic hemodialysis patients. Correlation with ventricular function, fluid removal and effect of hemodiafiltration

Abstract: Despite their elimination, BNP, NT-proBNP and proBNP could be potential markers of left ventricular remodeling in chronic renal failure patients on hemodialysis. According to these results, their cut-off values, however, need to be re-evaluated.

Cited by 49 publications

References 21 publications

Cardiac biomarkers for the diagnosis and monitoring of cardiovascular disease in the dialysis population

Cardiac biomarkers for the diagnosis and monitoring of cardiovascular disease in the dialysis population

Fluid-Volume Assessment in the Investigation of Acute Heart Failure

Relationship of Brain Natriuretic Peptide Concentrations to Left Ventricular Function and Adverse Outcomes in Children With End-Stage Renal Disease Undergoing Hemodialysis

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