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The use of B-type natriuretic peptide to assess volume status in patients with end-stage renal disease.
Am Heart J. 2007 Feb; 153(2):244.e1-5.AH

Abstract

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.

Authors+Show Affiliations

Division of Cardiology, the Department of Medicine, Veteran's Affairs Medical Center and University of California, San Diego, CA 92161, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17239684

Citation

Sheen, Victoria, et al. "The Use of B-type Natriuretic Peptide to Assess Volume Status in Patients With End-stage Renal Disease." American Heart Journal, vol. 153, no. 2, 2007, pp. 244.e1-5.
Sheen V, Bhalla V, Tulua-Tata A, et al. The use of B-type natriuretic peptide to assess volume status in patients with end-stage renal disease. Am Heart J. 2007;153(2):244.e1-5.
Sheen, V., Bhalla, V., Tulua-Tata, A., Bhalla, M. A., Weiss, D., Chiu, A., Abdeen, O., Mullaney, S., & Maisel, A. (2007). The use of B-type natriuretic peptide to assess volume status in patients with end-stage renal disease. American Heart Journal, 153(2), e1-5.
Sheen V, et al. The Use of B-type Natriuretic Peptide to Assess Volume Status in Patients With End-stage Renal Disease. Am Heart J. 2007;153(2):244.e1-5. PubMed PMID: 17239684.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The use of B-type natriuretic peptide to assess volume status in patients with end-stage renal disease. AU - Sheen,Victoria, AU - Bhalla,Vikas, AU - Tulua-Tata,Alisi, AU - Bhalla,Meenakshi A, AU - Weiss,Danielle, AU - Chiu,Albert, AU - Abdeen,Omaran, AU - Mullaney,Scott, AU - Maisel,Alan, PY - 2005/06/17/received PY - 2006/10/29/accepted PY - 2007/1/24/pubmed PY - 2007/3/21/medline PY - 2007/1/24/entrez SP - 244.e1 EP - 5 JF - American heart journal JO - Am Heart J VL - 153 IS - 2 N2 - 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. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/17239684/The_use_of_B_type_natriuretic_peptide_to_assess_volume_status_in_patients_with_end_stage_renal_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(06)01044-1 DB - PRIME DP - Unbound Medicine ER -