Background: We studied the influence of acute renal failure (ARF) on the relationship between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and hemodynamic parameters. Methods: The echocardiographic parameters and NT-proBNP levels were compared between 26 mechanically ventilated patients with ARF requiring continuous hemodiafiltration and 44 control patients. Results: The relationships between NT-proBNP and left ventricular ejection fraction (p = 0.001), left ventricular end-diastolic volume (p = 0.03), tricuspid annular plane systolic excursion (p = 0.008), and pulmonary artery pressure (p = 0.01) were found only in the control group. The median and interquartile range of NT-proBNP (1,717.5, 389.5–4,138 ng/l) were significantly higher (p < 0.001) in the low diuresis subgroup than the levels (748.8, 384.2–2,217 ng/l) in the subgroup where daily diuresis increased and both had significantly higher levels than controls (350.7, 130.2–661.2 ng/l, p < 0.001). Conclusion: The high levels of NT-proBNP >1,000 ng/l seem to be typical, particularly for oliguric ARF. It seems that ARF precludes its utilization for any hemodynamic diagnosis.

1.
Levitt JE, Vinayak AG, Gehlbach BK, Pohlman A, Van Cleve W, Hall JB, Kress JP: Diagnostic utility of B-type natriuretic peptide in critically ill patients with pulmonary edema: a prospective cohort study. Crit Care 2008;12:R3.
2.
Betti I, Castelli G, Barchielli A, Cinzia B, Boscherini V, De Luca L, Messeri G, Gheorghiade M, Maisel A, Zuppiroli A: The role of N-terminal PRO-brain natriuretic peptide and echocardiography for screening asymptomatic left ventricular dysfunction in a population at high risk for heart failure. The PROBE-HF study. J Card Fail 2009;15:377–384.
3.
O’Donoghue M, Chen A, Baggish AL, Anwaruddin S, Krauser DG, Tung R, Januzzi JL: The effects of ejection fraction on N-terminal ProBNP and BNP levels in patients with acute CHF: analysis from the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) study. J Card Fail 2005;11:S9–S14.
4.
Levin ER, Gardner DG, Samson WK: Natriuretic peptides. N Engl J Med 1998;339:321–328.
5.
Shimizu H, Masuta K, Asada H, Sugita K, Sairenji T: Characterization of molecular forms of probrain natriuretic peptide in human plasma. Clin Chim Acta 2003;334:233–239.
6.
McLean A, Huang S, Hyams S, Poh G, Nalos M, Pandit R, Balik M, Tang B, Seppelt I: Prognostic values of B-type natriuretic peptide in severe sepsis and septic shock. Crit Care Med 2007;35:1019–1026.
7.
Jefic D, Lee JW, Jefic D, Savoy-Moore RT, Rosman HS: Utility of B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide in evaluation of respiratory failure in critically ill patients. Chest 2005;128:288–295.
8.
Meyer B, Huelsmann M, Wexberg P, Karth GD, Berger R, Moertl D, Szekeres T, Pacher R, Heinz G: N-terminal pro-B-type natriuretic peptide is an independent predictor of outcome in an unselected cohort of critically ill patients. Crit Care Med 2007;35:2268–2273.
9.
Charpentier J, Luyt CE, Fulla Y, Vinsonneau C, Cariou A, Grabar S, Dhainaut JF, Mira JP, Chiche JD: Brain natriuretic peptide: a marker of myocardial dysfunction and prognosis during severe sepsis. Crit Care Med 2004;32:660–665.
10.
Rana R, Vlahakis VE, Daniels CE, Jaffe AS, Klee GG, Hubmayr RD, Gajic O: B-type natriuretic peptide in the assessment of acute lung injury and cardiogenic pulmonary edema. Crit Care Med 2006;34:1941–1946.
11.
Mekontso-Dessap A, de Prost N, Girou E, Braconnier F, Lemaire F, Brun-Buisson C, Brochard L: B-type natriuretic peptide and weaning from mechanical ventilation. Intensive Care Med 2006;32:1529–1536.
12.
Phua J, Lim TK, Lee KH: B-type natriuretic peptide: Issues for the intensivist and pulmonologist. Crit Care Med 2005;33:2094 –2103.
13.
Logeart D, Saudubray C, Beyne P, Thabut G, Ennezat PV, Chavelas C, Zanker C, Bouvier E, Solal AC: Comparative value of Doppler echocardiography and B-type natriuretic peptide assay in the etiologic diagnosis of acute dyspnea. J Am Coll Cardiol 2002;40:1794–1800.
14.
Pirracchio R, Deye N, Lukaszewicz AC, Mebazaa A, Cholley B, Mateo J, Megarbane B, Launay LM, Peynet J, Baud F, Payen D: Impaired plasma B-type natriuretic peptide clearance in human septic shock. Crit Care Med 2008;36:2542–2546.
15.
Smith MW, Espiner EA, Yandle YA, Charles CJ, Richards AM: Delayed metabolism of human brain natriuretic peptide reflects resistance to neutral endopeptidase. J Endocrinol 2000;167:239–246.
16.
Krauser DG, Lloyd-Jones DM, Chae CU, Cameron R, Anwaruddin S, Baggish AL, Chen A, Tung R, Januzzi JL Jr: Effect of body mass index on natriuretic peptide levels in patients with acute congestive heart failure: a ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) substudy. Am Heart J 2005;149:744–750.
17.
Das SR, Abdullah SM, Leonard D, Drazner MH, Khera A, McGuire DK, de Lemos JA: Association between renal function and circulating levels of natriuretic peptides (from the Dallas Heart Study). Am J Cardiol 2008;102:1394–1398.
18.
Anwaruddin S, Lloyd-Jones DM, Baggish A, Chen A, Krauser D, Tung R, Chae C, Januzzi JL: Renal function, congestive heart failure, and amino-terminal pro-brain natriuretic peptide measurement: results from the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) Study. J Am Coll Cardiol 2006;47:91–97.
19.
Jarai R, Fellner B, Haoula D, Jordanova N, Heinz G, Karth GD, Huber K, Geppert A: Early assessment of outcome in cardiogenic shock: relevance of plasma N-terminal pro-B-type natriuretic peptide and interleukin-6 levels. Crit Care Med 2009;37:1837–1844.
20.
Balik M, Jabor A, Kolar M, Pavlisova M, Brestan D, Hendl J, Rychlik I, Pachl J: Relationship between natriuretic peptides and residual diuresis during continuous hemodiafiltration. Blood Purif 2003;21:401–408.
21.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, and the ADQI Workgroup: Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Critical Care 2004;8:R204–R212
22.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G: SCCM/ESICM/ACCP/ATS/SIS 2001. SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003;31:1250–1256.
23.
Otto MC: Echocardiographic evaluation of left and right ventricular systolic function; in Otto MC (ed): Textbook of Clinical Echocardiography. Philadelphia, Saunders, 2000, pp 100–131.
24.
Nishimura RA, Tajik AJ: Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician’s rosseta stone. J Am Coll Cardiol 1997;30:8–18.
25.
Lonnemann G, Linnenweber S, Burg M, Koch KM: Transfer of endogenous pyrogens across artificial membranes? Kidney Int 1998;53:43–46.
26.
Bragg-Gresham JL, Fissell RB, Mason NA, Bailie GR, Gillespie BW, Wizemann V, Cruz JM, Akiba T, Kurokawa K, Ramirez S, Young EW: Diuretic use, residual renal function, and mortality among hemodialysis patients in the Dialysis Outcomes and Practice Pattern Study (DOPPS). Am J Kidney Dis 2007;49:426–431.
27.
Guerin C, Girard R, Selli JM, Ayzac L: Intermittent versus continuous renal replacement therapy for acute renal failure in intensive care units: results from a multicenter prospective epidemiological survey. Intensive Care Med 2002;28:1411–1418.
28.
Uchino S, Doig GS, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Nacedo E, Gibney N, Tolwani A, Ronco C, Kellum JA: Beginning and ending supportive therapy for the kidney (BEST kidney) investigators. Crit Care Med 2004;32:1669–1677.
29.
Chen AA, Wood MJ, Krauser DG, Baggish AL, Tung R, Anwaruddin S, Picard MH, Januzzi JL Jr: NT-proBNP levels, echocardiographic findings, and outcomes in breathless patients: results from the ProBNP Investigation of Dyspnoea in the Emergency Department (PRIDE) echocardiographic substudy. Eur Heart J 2006;27:839–845.
30.
Kotanidou A, Karsaliakos P, Tzanela M, Mavrou I, Kopterides P, Papadomichelakis E, Theodorakopoulou M, Botoula E, Tsangaris I, Lignos M, Ikonomidis I, Ilias I, Armaganidis A, Orfanos SE, Dimopoulou I: Prognostic importance of increased plasma amino-terminal pro-brain natriuretic peptide levels in a large noncardiac, general intensive care unit population. Shock 2009;31:342–347.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.