Brain Natriuretic Peptide (BNP): A New Risk Marker in Hemodialysis Patients?
AbstractIn this issue of the Southern Medical Journal, the authors raise the issue of B-type natriuretic peptide changes in end-stage renal disease.1 Brain natriuretic peptide (BNP) is a natriuretic hormone present in the brain and heart which is released from myocardial cells in response to volume and pressure overload.2 BNP is synthesized by cleavage of a precursor protein, proBNP, into a 32 amino acid-active hormone BNP2 and a biologically inactive 76 amino acid peptide N-terminal pro-BNP (NT-proBNP). BNP and NT-proBNP are released in a 1:1 ratio. In patients with asymptomatic or symptomatic left ventricular dysfunction (LVD), plasma NT-proBNP rises approximately fourfold higher than BNP concentrations,3 although the levels of both are increased. NT-proBNP is cleared renally rather than by neutral endopeptidases and clearance receptors, has a longer half-life (120 min vs. 20 min for BNP), and its levels show a greater correlation with glomerular filtration rate (GFR) than do BNP levels.4 It is important to keep in mind that the type of assay used, genetic variability, sex, and body mass index also can influence the determinations.4
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