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Abstract: PO2286

Use of B-Type Natriuretic Peptide as a Quantitative Marker of Fluid Overload in Neonatal Renal Replacement Therapy

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology


  • Nourbakhsh, Noureddin D., Rady Children's Hospital San Diego, San Diego, California, United States
  • Benador, Nadine M., Rady Children's Hospital San Diego, San Diego, California, United States

Group or Team Name

  • Comprehensive Kidney Care Center, Rady Children's Hospital, San Diego

Neonatal renal replacement therapy (RRT) remains one of the most challenging dialysis scenarios in Pediatric Nephrology. Evaluation of dry weight can be particularly difficult as fluid overload may be mistaken for adequate nutritional weight gain. Physical exam is insensitive in assessing hypervolemia until significant fluid overload develops. Non-invasive BP measurements are often difficult to obtain as upper extremities are typically used for IV access and the patient's lack of cooperation alters measurement. B-type natriuretic peptide (BNP) has long been used in the evaluation of heart failure and has even been reported to be a marker of fluid overload in adult hemodialysis patients. In this study, we evaluate the role of BNP as a quantitative marker of fluid overload in a neonate with ESRD.

Case Description

A 3 week old child with bilateral renal agenesis required emergent RRT.
Following the failure of peritoneal dialysis in this 2.19 kg child, RRT modality was converted to hemodialysis (HD). Despite daily 3 hr HD treatments with ultrafiltration (UF) goals guided by weight, physical exam findings and blood pressure, patient developed bilateral pulmonary edema and an enlarged cardiac silhouette at 3 weeks of age. BNP was found to be > 5,000 pg/mL and RRT modality was changed to CVVHDF. BNP normalized after 4 days of CVVHDF, but upon transition to HD, she again developed fluid overload and required placement back on CVVHDF. Thereafter, BNP was utilized as a quantitative marker of fluid overload with UF goal guided by pre- and post-dialysis BNP levels. Applying this technique, the patient had no further episodes of fluid overload.


Providing successful dialysis in infants is more problematic than in older patients. To assess fluid overload in children on dialysis, traditional tools include clinical assessment, serial weights and measuring blood pressure. In this infant, measurement of serial BNP levels allowed for an objective assessment of volume status, which was helpful in maintaining dry weight and lead to successful dialysis therapy.