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

Abstract

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.

Is N-terminal pro-brain natriuretic peptide a reliable marker for body fluid status in children with chronic kidney disease?

“…Kumar et al [40] measured NT-proBNP in 366 stable outpatients undergoing hemodialysis with a corresponding pre-and post-dialysis multifrequency bioimpedance assessment of extracellular water and they reported that serial NT-proBNP values may aid clinical assessments of volume status in patients undergoing dialysis. Ouali et al [41] identified a significant correlation between BNP concentrations and left ventricle functions in patients with CKD undergoing hemodialysis.…”

Kronik böbrek yetersizliği olan çocuklarda hemodiyalizin kardiyak etkileri

“…High plasma BNP levels were reported as a risk factor for cardiovascular morbidity and mortality in children with end-stage renal disease undergoing hemodialysis. Significant correlation was detected between BNP concentrations and left ventricle functions from Ouali et al 25 . Liu and colleagues were determined as BNP cut-off value as 353 pg/mL in adults undergoing hemodialysis with normal EF value 26 .…”

B‐type natriuretic peptide is a useful biomarker for the estimation of volume overload in children with hypertension on peritoneal dialysis

“…There are conflicting reports about the value of BNP as a biomarker of volume status in CKD patients. Some reports showed that BNP did not change significantly after the reduction of body weight in children on HD, but in others, BNP decreased significantly after HD . The reduction of BNP was interpreted as a reduction of plasma volume and relief of hypervolaemia after HD .…”