scholarly journals Brain Natriuretic Peptide Is a Marker of Fluid Overload in Incident Hemodialysis Patients

2017 ◽  
Vol 7 (3) ◽  
pp. 218-226 ◽  
Author(s):  
Charles Chazot ◽  
Margaux Rozes ◽  
Cyril Vo-Van ◽  
Patrik Deleaval ◽  
Jean-Marc Hurot ◽  
...  
Keyword(s):  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Patient Survival ◽  
Stepwise Multiple Regression ◽  
Hydration Status ◽  
Blood Levels ◽  
Dialysis Session ◽  
Fluid Removal ◽  
Significant Difference ◽  
Cardiac Status

Background/Aims: Brain natriuretic peptide (BNP) is secreted by cardiomyocytes under stretch condition. High blood levels are associated with decreased patient survival in heart failure patients and in hemodialysis (HD) patients. We report the monthly BNP change in the first months of HD therapy in incident patients and its relationship with fluid removal and cardiac history (CH). Methods: All patients starting HD therapy in our unit from May 2008 to December 2012 were retrospectively analyzed. Every month (M1 to M6), BNP was assessed before a midweek dialysis session. CH, monthly pre- and postdialysis blood pressure, and postdialysis body weight were collected. Results: A total of 236 patients were included in the analysis. The median BNP at HD start was 593 (175-1,433) pg/mL, with a significant difference between CH- and CH+ patients (291 vs. 731 pg/mL, p < 0.0001). Mortality was significantly higher in patients in the higher BNP tertile. BNP decreased significantly between M1 and M2 and then plateaued. The BNP change between M1 and M2 and between M1 and M6 was significantly correlated with the initial fluid removal. Applying stepwise multiple regression, the BNP change between M1 and M2 was significantly and independently related to fluid removal. The BNP level at M6 was also related to patient survival. Conclusions: We confirm that in incident HD patients, BNP level is related to fluid excess and cardiac status. The BNP decrease in the first months of HD therapy is related to fluid excess correction. BNP appears as an important tool to evaluate hydration status correction after HD onset.

scholarly journals Hypermethylation of brain natriuretic peptide gene is associated with the risk of rheumatic heart disease

2017 ◽  
Vol 37 (1) ◽  
Author(s):  
Ni Li ◽  
Dawei Zheng ◽  
Lebo Sun ◽  
Huoshun Shi ◽  
Xiuying Zhu ◽  
...  
Keyword(s):  
Heart Disease ◽  
Brain Natriuretic Peptide ◽  
Rheumatic Heart Disease ◽  
Natriuretic Peptide ◽  
Anticoagulant Therapy ◽  
Significant Difference ◽  
Term Administration ◽  
Promoter Dna ◽  
Peptide Gene ◽  
Rheumatic Heart

To investigate the contribution of brain natriuretic peptide (BNP) promoter DNA methylation to the risk of rheumatic heart disease (RHD) and the influence of warfarin anticoagulant therapy on BNP methylation levels for RHD patients after surgery. BNP methylation levels were determined by bisulfite pyrosequencing from plasma samples of RHD patients compared with healthy controls. Several factors influencing the RHD patients were included like age, smoking and cholesterol levels. A fragment of five CG sites (CpG1–5) in the promoter region of BNP gene was measured. BNP gene hypermethylation was found in CpG4 and CpG5 in RHD patients compared with non-RHD controls. A significant difference was also observed between RHD patients with long-term administration of warfarin and RHD patients who had recently undergone an operation. Moreover, single CpG4 and CpG5 analysis revealed a significant increase in methylation levels in men. BNP gene body hypermethylation is associated with the risk of RHD, and also influenced by the warfarin anticoagulant therapy of RHD patients after surgery, which could represent novel and promising targets for therapeutic development.

The diagnostic utility of brain natriuretic peptide in heart failure patients presenting with acute dyspnea: a meta-analysis

2013 ◽  
Vol 51 (6) ◽  
Author(s):  
Paolo Mastandrea
Keyword(s):  
Heart Failure ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Meta Analysis ◽  
Heart Association ◽  
Laboratory Method ◽  
Significant Heterogeneity ◽  
Acute Dyspnea ◽  
Significant Difference ◽  
Meta Regression

AbstractHeart failure with normal ejection fraction (HFNEF) accounts for approximately 50% of heart failure (HF) cases. To establish the utility of brain natriuretic peptide (BNP) in differentiating HF-related severe dyspnea from non-HF-related acute dyspnea, we used an estimation formula (eF) that was obtained from a series of three meta-regressions. We selected 60 out of 2721 case-control and follow-up studies that were published from 1998 to 2010. The heart failure levels (HFLs) were assessed using the New York Heart Association (NYHA) criteria. Random-effects meta-regression analyses of the natural logarithm (ln) of the BNP odds ratio (OR) were performed on the HFLs. The ln of the median BNP values (lnmBNP) was meta-regressed over the laboratory method (LM). A third meta-regression was performed on the HFLs to account for only the lnmBNP in the homogeneous LM subgroups. To determine the eF, the data from the diseased and control subjects were combined. The Bland-Altman method was used to detect eF bias. The overall BNP(OR) in the subgroup with severe HF was 35. The lnmBNP analysis showed that LM was a significant heterogeneity factor in the meta-regression (slope −0.38; CI −0.59 to −0.16). The meta-regression of lnmBNP on the HFL resulted in the following calculation for eF: estimated HFL (eHFL)=(lnmBNP–3.157)/0.886. The Bland-Altman test revealed no significant difference (0.0997; 95% CI −2.84 to 3.06) between HFL and eHFL. The severe eHFL showed a 78% accuracy. Based on the eF obtained from this meta-analysis, the BNP outcomes were shown to reliably diagnose severe dyspnea in HF and differentiate this condition from non-HF acute dyspnea.

scholarly journals Is Brain Natriuretic Peptide a Reliable Biomarker of Hydration Status in All Peritoneal Dialysis Patients?

2014 ◽  
Vol 37 (3) ◽  
pp. 238-242 ◽  
Author(s):  
Carlo Crepaldi ◽  
Mitchel Rosner ◽  
Catarina Teixeira ◽  
Lourdes Blanca Martos ◽  
Francesca Katiana Martino ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Hydration Status ◽  
Dialysis Patients

scholarly journals Changes in the Levels of Modern Biomarkers in Patients with Decompensated Heart Failure After Myocardial Infarction Under the Influence of Treatment with Succinic Acid and Arginine Preparations

2019 ◽  
Vol 26 (4) ◽  
Author(s):  
Khrystyna Levandovska
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Brain Natriuretic Peptide ◽  
Succinic Acid ◽  
Natriuretic Peptide ◽  
Decompensated Heart Failure ◽  
Developed Countries ◽  
Blood Levels ◽  
And Gender ◽  
Q Wave

The prevalence of heart failure in Europe and worldwide is high. This syndrome is a common cause of hospitalization and has a significant impact on morbidity, mortality and healthcare costs in highly developed countries. The study of biomarkers in heart failure is of wide interest as they can improve diagnosis, predict the development of heart failure and its decompensation, and help in assessing treatment outcomes.            The objective of the research was to study the feasibility of using multiple biomarker strategy for diagnosing decompensated heart failure in the post-infarction period and to assess changes in these markers after treatment with succinic acid and arginine preparations.          Materials and Methods. There were examined 120 patients with Q-QS wave and non-Q wave myocardial infarction complicated by decompensated heart failure. All the patients were divided into 2 groups (depending on Q-QS wave and non-Q wave myocardial infarction) and 4 subgroups (depending on rehabilitation therapy) being homogenous by age and gender.   Results. When studying the dynamics of changes in blood level of N-terminal pro-B-type brain natriuretic peptide and ST2, there was observed its significant reduction in all the patients with prior Q-QS wave myocardial infarction complicated by decompensated heart failure after treatment. The most significant changes were observed in the patients of Group IV who, on the background of basic therapy, received succinic acid and arginine preparations according to the proposed scheme. The combined use of arginine preparations and succinic acid in combination therapy for decompensated heart failure secondary to prior Q-QS wave myocardial infarction allowed reducing blood levels of N-terminal pro-B-type brain natriuretic peptide under conditions of graded exercises. Similar tendencies were observed when determining this indicator in the patients with non-Q wave myocardial infarction complicated by decompensated heart failure after rehabilitation treatment.    Conclusions. The use of succinic acid and arginine preparations when treating the patients with prior Q-QS wave and non-Q wave myocardial infarction complicated by decompensated heart failure allowed us to significantly reduce the level of immunological enzymes such as N-terminal pro-B-type brain natriuretic peptide and ST2, which indicate the presence and development of decompensated heart failure after myocardial infarction.

scholarly journals Utility of N-terminal pro-brain natriuretic peptide in detecting diastolic dysfunction in asymptomatic hypertensive patients: comparison with echocardiography

2019 ◽  
Vol 11 (1) ◽  
pp. 14-18
Author(s):  
Sahadeb Prasad Dhungana ◽  
Prahlad Karki ◽  
Madhab Lamsal
Keyword(s):  
Early Detection ◽  
Brain Natriuretic Peptide ◽  
Diastolic Dysfunction ◽  
Natriuretic Peptide ◽  
Systolic Function ◽  
Left Ventricular ◽  
Hypertensive Patients ◽  
Significant Difference ◽  
Echocardiographic Parameters ◽  
Lv Diastolic Dysfunction

Introduction: Data suggest that brain natriuretic peptide (BNP) and NT pro-BNP partially reflect ventricular pressure and could have a role in the early detection of diastolic abnormalities in hypertensive patients with normal systolic function. This study aimed to assess the role of NT pro-BNP for early detection of diastolic dysfunction in patients with hypertension and to correlate its level with echocardiographic parameters of diastolic dysfunction. Methods: This is a comparative cross-sectional study. Hundred cases of asymptomatic hypertensive patients with normal left ventricular (LV) systolic function and 100 healthy subjects were subjected to echocardiography and measurement of serum NT-pro BNP who received care at outpatient department of internal medicine, B.P. Koirala Institute of health sciences, Nepal. Results: Both systolic and diastolic blood pressures were significantly higher (≥160 and/or 100 mm Hg) in cases compared to controls (<120/80 mm Hg). Echocardiographic parameters of diastolic dysfunction: E/A ratio, E/E’ratio, deceleration time and isovolumetric relaxation time showed a significant difference between cases and controls. Mean serum NT-proBNP was significantly higher in patients with hypertension (213.19 ±184.3 pg/mL) compared to controls (58.51 ± 11.01 pg/mL) (P=0.008). There was no significant difference in mean serum NT-pro BNP levels between cases with no LV diastolic dysfunction (n=14) and controls (n=100) but it showed a significant difference between cases with LV diastolic dysfunction of all grades (n=86) and controls (n=100) (P=0.00). NT-proBNP levels were higher in both group of patients with E/A ratios <0.9 and 0.9-1.5 (245.72 ± 166.73 pg/mL and 210.69 + 143.53 pg/mL respectively) as compared to controls. Mean serum NT-proBNP levels were significantly higher in patients with IVRT >90 ms (270.43 ± 180.81 pg/mL) as compared to controls (P=0.03) but the difference was not significant between cases with IVRT of 60-90 ms (152.02 ± 100.23 pg/mL) and controls (P=0.09). NT-proBNP levels were significantly higher in all groups of patients with E/E’ ratios <8, 8-12, >12 (197 ± 121.25 pg/mL, 263.12 ± 122.52 pg/mL and 180 ± 106.56 pg/mL respectively) compared to controls. Conclusion: Mean serum NT-proBNP was significantly higher in patients with hypertension as compared to controls. There is some correlation between echocardiographic parameters of diastolic dysfunction and serum NT-proBNP. Hence, NT-proBNP may be useful for early detection of LV diastolic dysfunction in patients with hypertension.

Even a Moderate Fluid Removal Rate during Individualised Haemodialysis Session Times Is Associated with Decreased Patient Survival

2017 ◽  
Vol 44 (2) ◽  
pp. 89-97 ◽  
Author(s):  
Charles Chazot ◽  
Cyril Vo-Van ◽  
Christie Lorriaux ◽  
Patrik Deleaval ◽  
Brice Mayor ◽  
...  
Keyword(s):  
Patient Survival ◽  
Removal Rate ◽  
Residual Renal Function ◽  
Dialysis Session ◽  
Dialysis Patients ◽  
Fluid Removal ◽  
Β2 Microglobulin ◽  
Session Time ◽  
Interdialytic Weight Gain ◽  
Kaplan Meier

Background: Several studies report that fluid removal rate (FRR) above 10-13 mL/h/kg is associated with increased mortality in haemodialysis (HD) patients. Aim: The aims of this study are to assess the influence of moderate FRR on survival in a cohort of prevalent dialysis patients with various dialysis session times and to challenge the FRR thresholds associated with increased mortality risk reported previously. Methods: Interdialytic weight gain (IDWG) and FRR (calculated from ultrafiltration [UF], target weight, and session time prescriptions) were studied in 190 prevalent dialysis patients (female: 42%, mean age: 69.5 years, median vintage: 40.2 months, diabetes: 34.7%, loop diuretic prescription: 5.8%) and averaged during the final quarter of 2010. Patient survival was analysed using Kaplan-Meier and Cox-multivariate analyses. Results: The median IDWG, median session time, and median FRR were 2.33 kg (-0.54-4.57), 5.0 h (3.9-8.0 h), 6.8 mL/h/kg (1.3-16.7), respectively, and FRR was ≥10 mL/h/kg in 11.6% of the patients. The Kaplan-Meier analysis showed decreased patient survival when the FRR was above the median (6.8 mL/h/kg; p = 0.012). The FRR was found to be independently associated with increased mortality (hazard ratio 1.15 [95% CI 1.02-1.29]; p = 0.027) using stepwise Cox proportional hazard regression analysis, including age, vintage, gender, body mass index (BMI), serum albumin level, β2-microglobulin level, cardiovascular and diabetes history, and session time. Online haemodiafiltration did not change this result. The role of residual renal function was unlikely because 74% of the patients had a vintage of >18 months, a minority (5.8%) were prescribed loop diuretics (a surrogate of significant urine output) and β2-microglobulin level was not different in patients who were below or above the FRR median. Conclusion: We concluded that the FRR threshold above which there is an increased mortality is lower than what has been reported (7.8 mL/h/kg). It raises the question of the hazard of fluid removal and intermittence of standard HD.

Sign in / Sign up

Export Citation Format

Share Document