The use of B-type natriuretic peptide to assess volume status in patients with end-stage renal disease

Sheen, Victoria; Bhalla, Vikas; Tulua-Tata, Alisi; Bhalla, Meenakshi; Weiss, Danielle E.; Chiu, Albert; Abdeen, Omaran; Mullaney, Scott; Maisel, Alan S.

doi:10.1016/j.ahj.2006.10.041

Cited by 54 publications

(43 citation statements)

References 20 publications

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“…In this study there was no significant correlation between BNP levels and presence of hypertension or presence of diabetes. These results agreed with Sheen, et al [23], who reported that the correlation of BNP changes, whether intra or inter-dialytic did not correlate with changes in weight, systolic and diastolic blood pressure. These results were attributed to several possibilities which may explain this negative finding.…”

Section: Discussionsupporting

confidence: 83%

A Cut off Value for Brain Natriuretic Peptide Indicating Volume Overload in Hemodialysis Patients

Baki¹,

Mohab²,

Reda³

et al. 2017

J Kidney

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Section: Discussionsupporting

confidence: 83%

A Cut off Value for Brain Natriuretic Peptide Indicating Volume Overload in Hemodialysis Patients

Baki¹,

Mohab²,

Reda³

et al. 2017

J Kidney

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“…Imaging studies by CMR occurred on a midweek postdialysis day at baseline and 12 months to avoid the long interdialytic break after the weekend, when patients are most hypervolemic (13,14). Studies were conducted at two centers using a 1.5-T scanner (GE Signa HDxt; GE Healthcare, Milwaukee, WI) by validated methods (15).…”

Section: Data Collectionmentioning

confidence: 99%

Randomized Controlled Trial of Individualized Dialysate Cooling for Cardiac Protection in Hemodialysis Patients

Odudu

Eldehni

McCann

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Cardiovascular disease is the most common cause of death in patients on hemodialysis (HD). HD-associated cardiomyopathy is appreciated to be driven by exposure to recurrent and cumulative ischemic insults resulting from hemodynamic instability of conventionally performed intermittent HD treatment itself. Cooled dialysate reduces HD-induced recurrent ischemic injury, but whether this confers long-term protection of the heart in terms of cardiac structure and function is not known.Design, setting, participants, & measurements Between September 2009 and January 2013, 73 incident HD patients were randomly assigned to a dialysate temperature of 37°C (control) or individualized cooling at 0.5°C below body temperature (intervention) for 12 months. Cardiac structure, function, and aortic distensibility were assessed by cardiac magnetic resonance imaging. Mean between-group difference in delivered dialysate temperature was 1.2°C60.3°C. Treatment effects were determined by the interaction of treatment group with time in linear mixed models.Results There was no between-group difference in the primary outcome of left ventricular ejection fraction (1.5%; 95% confidence interval, -4.3% to 7.3%). However, left ventricular function assessed by peak systolic strain was preserved by the intervention (-3.3%; 95% confidence interval, -6.5% to -0.2%) as was diastolic function (measured as peak diastolic strain rate, 0.18 s 21 ; 95% confidence interval, 0.02 to 0.34 s 21 ). Reduction of left ventricular dilation was demonstrated by significant reduction in left ventricular end-diastolic volume (-23.8 ml; 95% confidence interval, -44.7 to -2.9 ml). The intervention was associated with reduced left ventricular mass (-15.6 g; 95% confidence interval, -29.4 to -1.9 g). Aortic distensibility was preserved in the intervention group (1.8 mmHg 21 310 23 ; 95% confidence interval, 0.1 to 3.6 mmHg 21 310 23 ). There were no intervention-related withdrawals or adverse events.

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“…Safley and colleagues 19 also found that urea reduction rate and change of BNP did correlate. The study by Sheen and coworkers 17 found that BNP can decrease toward the end of the week even without changing the dry weight or UF volume. They, however, only considered UF as the sole mechanism of intravascular fluid removal.…”

Section: Discussionmentioning

confidence: 99%

“…13 Physical examination is not only inadequate for the detection of volume overload, but it is also unable to accurately detect volume depletion. 14 Some previous studies have questioned the validity of BNP utilization in ESRD [15][16][17] and found ''no correlation between the plasma levels of BNP and body weight changes during HD.'' 15 In a review article by Ishibe and Peixoto, 18 the use of this test was found to be still too controversial for the assessment of intravascular volume.…”

Section: Discussionmentioning

confidence: 99%

B‐Type Natriuretic Peptide–Directed Ultrafiltration Improves Care in Acutely Hospitalized Dialysis Patients

Tapolyai

Uysal

Maeweathers

et al. 2009

Congestive Heart Failure

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In an observational study in 19 consecutive acutely hospitalized dialysis patients, ultrafiltration (UF) volume was determined by B‐type natriuretic peptide (BNP) levels. Patients were ultrafiltrated daily until they achieved a target BNP level <500 pg/mL. The UF volumes ranged from 2 to 5 L per session. All patients were male veterans aged 68±11 years (mean ± SD), 74% were diabetic, 47% were African Americans, 58% underwent prevalent dialysis, and 53% had an arteriovenous fistula. Left ventricular ejection fraction on 2‐dimensional echocardiography was 43.8%±27.9% (n=16). The admission BNP was 2412±1479 pg/mL (range, 561–5000 pg/mL) and BNP at hospital discharge was 1245±1173 pg/mL (range, 345–5000 pg/mL) (nonparametric Wilcoxon P=.0013). Admission weight was 88.9±27.9 kg and at discharge was 78.1±25.6 kg (P=.0002). The number of antihypertensive medications taken was 3.8±2.0 at admission and 2.3±1.7 at discharge (P=.0005). The number of patients with >2 blood pressure medications decreased from 14 to 6 (Fisher exact test, P=.02). The systolic/diastolic/mean arterial blood pressure decreased from admission to discharge (153.6±43.8/80.6±21.8/102.4±27.3 to 132.1±27.9/68.9±14.6/89.9±16.5 mm Hg; P=.0222/.0139/.0329, respectively). Although all patients were volume‐overloaded at admission according to BNP criteria (>500), only 42% were identified as having heart failure. BNP‐directed UF is safe because it minimizes symptomatic hypotension, identifies occult congestive heart failure in a large number of patients, and significantly reduces blood pressure in addition to reducing body weight and number of medications used.

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The use of B-type natriuretic peptide to assess volume status in patients with end-stage renal disease

Cited by 54 publications

References 20 publications

A Cut off Value for Brain Natriuretic Peptide Indicating Volume Overload in Hemodialysis Patients

A Cut off Value for Brain Natriuretic Peptide Indicating Volume Overload in Hemodialysis Patients

Randomized Controlled Trial of Individualized Dialysate Cooling for Cardiac Protection in Hemodialysis Patients

B‐Type Natriuretic Peptide–Directed Ultrafiltration Improves Care in Acutely Hospitalized Dialysis Patients

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