Original Article

Blood B-Type Natriuretic Peptide and Dialysis: Present Assessment and Future Analyses

Authors: Mark Flemmer, MD, Hussein Rajab, MD, Tracy Mathena, MD, James Paulson, PhD, Susan Perkins, MS, Thomas Whelan, MD, Ritche Chiu, MD, Peter A. McCullough, MD, MPH

Abstract


Brain natriuretic peptide (BNP) is elevated in hemodialysis (HD) patients and predicts increased mortality. Intra- and interdialytic changes in BNP have not been fully described.


End-stage renal disease (ESRD) patients were prospectively recruited at three dialysis centers. At five visits, over a 6-week period, pre- and postdialysis BNP levels were measured. Pre- and postdialysis weights, blood pressure, fluid removed/given and demographic/medical information were recorded.


Mean pre- and post-HD BNP (log-transformed) was not significantly different and did not correlate with fluid removed. Both pre- and post-HD BNP significantly decreased across the dialysis week (Pre-HD: intercept = 2.69, slope = −0.097, t = −6.7, P < 0.001) and across the five sessions (slope = −0.046, t = −2.47, P = 0.01).


Interdialytic BNP changes are not related to fluid removed. Chronic volume overload and increased left ventricular wall tension likely account for the BNP decrease across dialysis weeks and may be related to higher death rates among HD patients at the beginning of the week.



This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1.Mueller C, Scholer A, Laule-Kilian K, et al. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J Med 2004;350:647–654.
 
2.de Lemos JA, McGuire DK, Drazner MH. B-type natriuretic: peptide in cardiovascular disease. Lancet 2003;362:316–322.
 
3.Zoccali C, Mallamaci F, Benedetto F, et al; Creed Investigators. Cardiac natriuretic peptides are related to left ventricular mass and function and predict mortality in dialysis patients. J Am Soc Nephrol 2001;12:1508–1515.
 
4.Naganuma T, Sugimura K, Wada S, et al. The prognostic role of brain natriuretic peptides in hemodialysis patients. Am J Nephrol 2002;22:437–444.
 
5.Iwashima Y, Horio T, Takami Y, et al. Effects of the creation of arteriovenous fistula for hemodialysis on cardiac function and natriuretic peptide levels in CRF. Am J Kidney Dis 2002;40:974–982.
 
6.Ishizaka H, Yamamoto Y, Fukunaga T, et al. Plasma concentrations of human brain natriuretic peptide in dialysis patients. Am J Kidney Dis 1994;24:461–472.
 
7.Akiba T, Tachibana K, Togashi K, et al. Plasma human brain natriuretic peptide in chronic renal failure. Clin Nephrol 1995;44(suppl 1):S61–S64.
 
8.Mallamaci F, Zocalli C, Tripepi G, et al; CREED investigators. Diagnostic potential of cardiac natriuretic peptides in dialyisi patients. Kidney Int 2001;59:1559–1566.
 
9.Lee SW, Song JH, Kim GA, et al. Plasma brain natriuretic peptide concentration on assessment of hydration status in hemodialysis patients. Am J Kidney Dis 2003;41:1257–1266.
 
10.Sheen V, Bhalla V, Tulua-Tata A, et al. The use of a B-type natriuretic peptide to assess volume status in patients with end stage renal disease. Am Heart J 2007;153:244.e1–244.e5.
 
11.Corboy JC, Walker RJ, Simmonds MB, et al. Plasma natriuretic peptides and cardiac, during acute changes in intravascular, in haemodialysis patients. Clin Sci (Lond) 1994;87:679–684.
 
12.Nitta K, Kawashima A, Yumura W, et al. Plasma concentration of brain natriuretic peptide as an indicator of cardiac ventricular function in patients on hemodialysis. Am J Nephrol 1998;18:411–415.
 
13.Safley DM, Awad A, Sullivan RA, et al. Changes in B-type natriuretic peptide levels in hemodialysis and the effect of depressed left ventricular function. Adv Chronic Kidney Dis 2005;12:117–124.
 
14.SPSS for Windows [computer program]. Chicago, IL, SPSS Inc., 2006, version 15.0.
 
15.Raudenbush SW, Bryk AS, Cheong YF, et al. HLM 6: Hierarchical Linear and Nonlinear Modeling. Chicago, IL, SSI Scientific Software, 2004.
 
16.Easterling RE. Racial factors in the incidence and causation of end-stage renal disease (ESRD). Trans Am Soc Artif Intern Organs 1977;23:28–33.
 
17.Rostand SG, Kirk KA, Rutsky EA, et al. Racial differences in the incidence of treatment for end-stage renal disease. N Engl J Med 1982;306:1276–1279.
 
18.The Triage® BNP Test [Package Insert]. San Diego, CA, Biosite Inc., 2005.
 
19.Bleyer AJ, Russell GB, Satko SG. Sudden and cardiac death rates in hemodialysis patients. Kidney Int 1999;55:1553–1559.
 
20.Zeng CL, Wei TM, Jin L, et al. Value of B-type natriuretic peptide in dialysis-dependent patients. Intern Med J 2006;36:552–557.
 
21.van de Pol A, Frenken LA, Moret K, et al. An evaluation of blood volume changes during ultrafiltration pulses and natriuretic peptides in the assessment of dry weight in hemodialysis patients. Hemodial Int 2007;11:51–61.
 
22.Morishita Y, Ando Y, Ishii E, et al. Comparison of markers of circulating blood volume in hemodialysis patients. Clin Exp Nephrol 2005;9:233–237.
 
23.Sabatine M, Morrow DA, de Lemos JA, et al. Acute changes in circulating natriuretic peptide levels in relation to myocardial ischemia. J Am Coll Cardiol 2004;44:1988–1995.
 
24.Eknoyan G, Beck G, Cheung AK, et al. Effects of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 2002;347:2010–2019.
 
25.Odar-Cedelof, Bjellerup P, Williams A, et al. Daily dialyses decrease plasma levels of brain natriuretic peptide, a biomarker of left ventricular dysfunction. Hemodial Int 2006;10:394–398.
 
26.Nesrallah G, Garg AX, Moist LM, et al. The International Quotidian Dialysis Registry: annual report 2005. Hemodial Int 2005;9:203–209.
 
27.Culleton BF, Walsh M, Klarenbach SW, et al. Effect of frequent nocturnal hemodialysis vs. conventional hemodialysis on left ventricular mass and quality of life. JAMA 2007;298:1291–1299.