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The role of natriuretic peptides in volume assessment and mortality prediction in Haemodialysis patients
BACKGROUND: Maintaining optimal fluid balance is essential in haemodialysis (HD) patients but clinical evaluation remains problematic. Other technologies such as bioimpedance are emerging as valuable adjuncts. This study was undertaken to explore the potential utility of the natriuretic peptides – a...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2015
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4696232/ https://www.ncbi.nlm.nih.gov/pubmed/26714753 http://dx.doi.org/10.1186/s12882-015-0212-4 |
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author | Sivalingam, Murugan Vilar, Enric Mathavakkannan, Suresh Farrington, Ken |
author_facet | Sivalingam, Murugan Vilar, Enric Mathavakkannan, Suresh Farrington, Ken |
author_sort | Sivalingam, Murugan |
collection | PubMed |
description | BACKGROUND: Maintaining optimal fluid balance is essential in haemodialysis (HD) patients but clinical evaluation remains problematic. Other technologies such as bioimpedance are emerging as valuable adjuncts. This study was undertaken to explore the potential utility of the natriuretic peptides – atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) in the assessment of fluid status and cardiovascular risk in this setting. METHODS: This was a cross-sectional study carried out in an unselected cohort of 170 prevalent HD patients. Volume status was assessed by clinical parameters – the presence or absence of peripheral oedema, raised jugular venous pressure and basal lung crepitations; by extracellular fluid volume (ECFV) status determined by whole body bioimpedance; and by serum levels of BNP and ANP (pre- and post –dialysis). The relationships of ANP and BNP levels to clinical and bioimpedance parameters of volume status was determined. Patients were followed up for 5 years to assess the relationship of natriuretic peptide levels to mortality. RESULTS: Bioimpedance estimates of ECFV expansion (>105 % of ideal ECFV) was present in 52 % of patients pre-dialysis. A significant proportion (21 %) of pre-dialysis patients had a depleted ECFV (<95 % of ideal ECFV) pre-dialysis. The situation was reversed post-dialysis. A raised JVP >3 cm was the most reliable clinical sign of ECFV expansion inferred from bioimpedance measurements and natriuretic peptide levels. The vast majority of patients with this sign also had lung crepitations or peripheral oedema or both. BNP was a stronger predictor of ECFV expansion than either pre- or post-dialysis ANP. BNP was also a stronger predictor of five-year survival. CONCLUSION: Serum levels of BNP have a strong relationship to both volume status and survival in HD patients. We found no clear role for measurement of ANP, though changes in blood levels may be a sensitive indicator of acute changes in volume status. Whether monitoring levels of these peptides has a role in the management of volume status and cardiovascular risk requires further study. |
format | Online Article Text |
id | pubmed-4696232 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-46962322015-12-31 The role of natriuretic peptides in volume assessment and mortality prediction in Haemodialysis patients Sivalingam, Murugan Vilar, Enric Mathavakkannan, Suresh Farrington, Ken BMC Nephrol Research Article BACKGROUND: Maintaining optimal fluid balance is essential in haemodialysis (HD) patients but clinical evaluation remains problematic. Other technologies such as bioimpedance are emerging as valuable adjuncts. This study was undertaken to explore the potential utility of the natriuretic peptides – atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) in the assessment of fluid status and cardiovascular risk in this setting. METHODS: This was a cross-sectional study carried out in an unselected cohort of 170 prevalent HD patients. Volume status was assessed by clinical parameters – the presence or absence of peripheral oedema, raised jugular venous pressure and basal lung crepitations; by extracellular fluid volume (ECFV) status determined by whole body bioimpedance; and by serum levels of BNP and ANP (pre- and post –dialysis). The relationships of ANP and BNP levels to clinical and bioimpedance parameters of volume status was determined. Patients were followed up for 5 years to assess the relationship of natriuretic peptide levels to mortality. RESULTS: Bioimpedance estimates of ECFV expansion (>105 % of ideal ECFV) was present in 52 % of patients pre-dialysis. A significant proportion (21 %) of pre-dialysis patients had a depleted ECFV (<95 % of ideal ECFV) pre-dialysis. The situation was reversed post-dialysis. A raised JVP >3 cm was the most reliable clinical sign of ECFV expansion inferred from bioimpedance measurements and natriuretic peptide levels. The vast majority of patients with this sign also had lung crepitations or peripheral oedema or both. BNP was a stronger predictor of ECFV expansion than either pre- or post-dialysis ANP. BNP was also a stronger predictor of five-year survival. CONCLUSION: Serum levels of BNP have a strong relationship to both volume status and survival in HD patients. We found no clear role for measurement of ANP, though changes in blood levels may be a sensitive indicator of acute changes in volume status. Whether monitoring levels of these peptides has a role in the management of volume status and cardiovascular risk requires further study. BioMed Central 2015-12-29 /pmc/articles/PMC4696232/ /pubmed/26714753 http://dx.doi.org/10.1186/s12882-015-0212-4 Text en © Sivalingam et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Sivalingam, Murugan Vilar, Enric Mathavakkannan, Suresh Farrington, Ken The role of natriuretic peptides in volume assessment and mortality prediction in Haemodialysis patients |
title | The role of natriuretic peptides in volume assessment and mortality prediction in Haemodialysis patients |
title_full | The role of natriuretic peptides in volume assessment and mortality prediction in Haemodialysis patients |
title_fullStr | The role of natriuretic peptides in volume assessment and mortality prediction in Haemodialysis patients |
title_full_unstemmed | The role of natriuretic peptides in volume assessment and mortality prediction in Haemodialysis patients |
title_short | The role of natriuretic peptides in volume assessment and mortality prediction in Haemodialysis patients |
title_sort | role of natriuretic peptides in volume assessment and mortality prediction in haemodialysis patients |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4696232/ https://www.ncbi.nlm.nih.gov/pubmed/26714753 http://dx.doi.org/10.1186/s12882-015-0212-4 |
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