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Abstract: PO1112

Attenuated Renal Response to Endogenous Natriuretic Peptides in Heart Failure with Preserved Ejection Fraction

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

  • 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Agarwal, Adhish, University of Utah Health, Salt Lake City, Utah, United States
  • Beddhu, Srinivasan, University of Utah Health, Salt Lake City, Utah, United States
  • Boucher, Robert E., University of Utah Health, Salt Lake City, Utah, United States
  • Ramkumar, Nirupama, University of Utah Health, Salt Lake City, Utah, United States
  • Rodan, Aylin R., University of Utah Health, Salt Lake City, Utah, United States
  • Rao, Veena, Yale University, New Haven, Connecticut, United States
  • Mohammad, Habeeb, University of Utah Health, Salt Lake City, Utah, United States
  • Dranow, Elizabeth, University of Utah Health, Salt Lake City, Utah, United States
  • Wei, Guo, University of Utah Health, Salt Lake City, Utah, United States
  • Shah, Kevin S., University of Utah Health, Salt Lake City, Utah, United States
  • Fang, James Chen-Tson, University of Utah Health, Salt Lake City, Utah, United States
  • Cheung, Alfred K., University of Utah Health, Salt Lake City, Utah, United States
Background

The pathophysiology of sodium retention in heart failure with preserved ejection fraction (HFpEF) remains largely unknown. A potential mechanism is attenuated renal response to natriuretic peptides (NPs). Urinary cyclic guanosine monophosphate (ucGMP) is an intracellular messenger of NPs, and an attenuated ucGMP/B-type NP (BNP) ratio suggests decreased renal response to BNP. We hypothesized that patients with HFpEF have attenuated response to NPs.

Methods

We studied ucGMP/plasma BNP ratios in 9 HFpEF patients and 5 controls (no history of renal or heart disease). All participants were placed on a low (2-3 g/d) sodium diet for a week prior to the study. Urinary results were normalized using urine creatinine. Cases and controls were compared using Wilcoxon rank-sum tests.

Results

Mean age and body mass index for the HFpEF participants were 62+/-12 years and 36.3+/-8.5 Kg/m2, and for control participants were 47+/-18 years and 24.6+/-3.7 Kg/m2 respectively. Plasma BNP tended to be higher (median 54.0 (29.0, 118.0) versus 5.0 (5.0, 34.0) pg/ml; p = 0.15), while ucGMP/plasma BNP ratio was lower (median 0.7 (0.4, 0.8) versus 7.3 (1.7, 8.5) (pmol/mg)/(pg/ml); p = 0.014) in cases as compared to controls.

Conclusion

Our pilot study shows that ucGMP/plasma BNP ratio, which reflects renal response to BNP, was attenuated in patients with HFpEF. These data suggest that impaired renal response to NPs may be implicated in the pathogenesis of fluid retention in HFpEF.