Background: Though brain natriuretic peptide (BNP) is widely used as a clinical marker of cardiac function, there is considerable confusion in the interpretation of its value in hemodialysis (HD) patients whose BNPs are often elevated without cardiac diseases. The aim of the present study is to examine the predictive value of BNP for blood pressure (BP) fall during HD and cardiac function. Methods: Subjects consisted of 205 (160 males, 45 females; age 66.5 ± 10.5 years) consecutive uremic patients requiring maintenance HD who were admitted to our hospital during 2001–2004. One hundred and eleven cases had a history of ischemic heart disease. We measured BNP in all cases and collected clinical data including age, sex, duration of HD, blood examination and echocardiography. Results: BNP of all 205 cases ranged from 6 to 16,097 pg/ml (median 831). During HD, the average BP change was –24.5 ± 20.5 mm Hg, and 111 cases showed a systolic BP reduction >20 mm Hg. BNP did not predict the degree of BP fall. After adjusting confounding factors, the presence of ischemic heart disease, ultrafiltration rate, systolic BP before HD and serum sodium concentration showed a significant correlation with BP change (t = –2.84, –2.76, –4.68 and 2.90; p = 0.005, <0.01, <0.0001 and <0.005, respectively). In relation to echocardiographic indices, BNP >785 pg/ml could predict left ventricular dysfunction (fractional shortening of the left ventricle <30%, sensitivity 73%, specificity 65%). Conclusion: The level of BNP could not predict BP fall during HD. However, BNP is a good indicator of cardiac function even in uremic patients.

Keywords:
Brain natriuretic peptide, Hemodialysis, Cardiac function
1.
Kohse KP, Feifel K, Mayer-Westein R: Differential regulation of brain and atrial natriuretic peptides in hemodialysis patients. Clin Nephrol 1993;40:83–90.
2.
Buckley M, Sethi D, Markandu N, et al: Plasma concentration and comparison of brain natriuretic peptide and atrial natriuretic peptide in normal subjects, cardiac transplant recipients and patients with dialysis-independent and dialysis-dependent chronic renal failure. Clin Sci 1992;383:437–444.
3.
Yoshimura M, Yasue H, Okumura K, et al: Different secretion patterns of atrial natriuretic peptide and brain natriuretic peptide in patients with congestive heart failure. Circulation 1993;87:464–469.
4.
Davidson NC, Struthers AD: Brain natriuretic peptide. J Hypertens 1994;12:329–336.
5.
Iwanaga Y, Nishi I, Furuichi S, et al: B-type natriuretic peptide strongly reflects diastolic wall stress in patients with heart failure. J Am Coll Cardiol 2006;47:742–748.
6.
McCullough PA, Duc P, Omland T, et al: B-type natriuretic peptide and renal function in the diagnosis of heart failure; an analysis from the Breathing Not Properly Multinational Study. Am J Kidney Dis 2003;4:571–579.
7.
Mallamaci F, Zoccali C, Tripepi G, et al: Diagnostic potential of cardiac natriuretic peptides in dialysis patients. Kidney Int 2001;59:1559–1566.
8.
Zoccali C, Mallamaci F, Benedetto FA, et al: Cardiac natriuretic peptides are related to left ventricular mass and function and predict mortality in dialysis patients. J Am Soc Nephrol 2001;12:1508–15159.
9.
Eguchi K, Kario K, Hoshide S, et al: Greater change of orthostatic blood pressure is related to silent cerebral infarct and cardiac overload in hypertensive subjects. Hypertens Res 2004;27:235–241.
10.
Nishikimi T, Futoo Y, Tamano K, et al: Plasma brain natriuretic peptide levels in chronic hemodialysis patients: influence of coronary artery disease. Am J Kidney Dis 2001;37:1201–1208.
11.
Davis M, Espiner E, Richards G, et al: Plasma brain natriuretic peptide in assessment of acute dyspnea. Lancet 1994;343:440–444.
12.
Cowie MR, Struthers AD, Wood DA, et al: Value of natriuretic peptide in assessment of patients with possible new heart failure in primary care. Lancet 1997;350:1349–1353.
13.
Maise AS, Krishnaswamy P, Nowak RM, et al: Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002;347:161–167.
14.
Tsutamoto T, Wada A, Sakai H, et al: Relationship between renal function and plasma brain natriuretic peptide in patients with heart failure. J Am Coll Cardiol 2006;47:582–586.
© 2007 S. Karger AG, Basel
2007
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