Elsevier

American Heart Journal

Volume 153, Issue 2, February 2007, Pages 244.e1-244.e5
American Heart Journal

Clinical Investigation
Congestive Heart Failure
The use of B-type natriuretic peptide to assess volume status in patients with end-stage renal disease

https://doi.org/10.1016/j.ahj.2006.10.041Get rights and content

Background

Although B-type natriuretic peptide (BNP) levels correlate with volume overload in congestive heart failure, its usefulness in patients with renal dysfunction has been questioned. A simple test to estimate volume overload and assist in the management of dry weight in hemodialysis (HD) patients would be useful.

Methods

Thirty-nine patients—aged 64 ± 2 years (mean ± SEM), male-female ratio of 37:2—undergoing HD thrice weekly for at least 30 days were studied. Samples were collected at the start and end of each of 3 consecutive HD sessions. Pre- and postsession weights and blood pressures were recorded. Left ventricular ejection fractions were obtained from echocardiograms performed within 1 year of enrollment. The first session was the dialysis session after a 72-hour interdialytic period, whereas the second and third sessions were after a 48-hour period. Plasma volume changes were measured in a subset of 13 patients.

Results

Pre- and postdialysis BNP levels for each of the 3 sessions were 434 and 343 pg/mL, 347 and 231 pg/mL, and 249 and 202 pg/mL, respectively. The values for body weights were 82.6 ± 3.6 and 78.6 ± 3.5 kg, 81.5 ± 3.6 and 78.2 ± 3.5 kg, and 81.5 ± 3.46 and 78.3 ± 3.5 kg, respectively. The values of mean systolic blood pressures were 150 ± 4 and 134 ± 3 mm Hg, 142 ± 4 and 134 ± 4 mm Hg, and 142 ± 4 and 131 ± 4 mm Hg, respectively. The values for mean diastolic blood pressures were 81 ± 2.5 and 70 ± 2.4 mm Hg, 74 ± 2.4 and 72.1 ± 2.2 mm Hg, and 76 ± 2.9 and 72 ± 2.9 mm Hg, respectively. There was no correlation between changes in intradialytic BNP values and other measured parameters. Plasma volume changed minimally during dialysis.

Conclusions

Values of BNP are elevated in patients with end-stage renal disease and decline after each dialysis session. Over the course of a week, BNP levels gradually declined irrespective of changes in weight or blood pressure. The lack of correlation between changes in BNP and changes in measured clinical parameters is partly explained by a lack of a significant change in plasma volume. The highest BNP values were seen in patients with systolic dysfunction.

Section snippets

Study population

The University of California, San Diego, Institutional Review Board and the Veterans Affairs research committee approved this study. The participants included 39 patients with ESRD undergoing HD 3 times a week for at least 30 days at the San Diego Veterans Healthcare System. Blood samples were collected at the start and end of each of 3 consecutive dialysis sessions on a Monday-Wednesday-Friday or a Tuesday-Thursday-Saturday schedule. Pre- and posttreatment weights and blood pressures were

Overview

Table I shows the characteristics of all 39 patients—aged 64 ± 2 years (mean ± SEM), male-female ratio of 37:2—undergoing HD 3 times a week for at least 30 days. Most patients (95%) had a history of hypertension, whereas 68% had diabetes, 35% had congestive heart failure (CHF), 38% had coronary artery disease, and 24% had peripheral vascular disease. Patients underwent a total of 117 dialysis procedures conducted on either a Monday-Wednesday-Friday or Tuesday-Thursday-Saturday schedule. The

Discussion

Plasma BNP and estimated glomerular filtration rate have been shown to be related to prognosis in CHF.18, 19 However, the relationships between estimated glomerular filtration rate, BNP, and CHF are not fully understood. The BNP is cleared by the natriuretic peptide receptor system found both on the vascular endothelium and in the renal parenchyma. It is also cleared by plasma neutral endopeptidases, which are ubiquitous.20, 21 This suggests that endogenous BNP is cleared by both renal and

References (22)

  • P.M. Kouw et al.

    Assessment of postdialysis dry weight: a comparison of techniques

    J Am Soc Nephrol

    (1993)
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    Dr Maisel receives research support from Bayer Diagnostics (Tarrytown, NY), who supplied assay kits for this study.

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