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Abstract: PO1961

NT-ProBNP a Potential Biomarker for Assessing Volume Status of Patients Receiving CRRT

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Chadha, Vimal, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
  • Benton, Tara, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
  • Warady, Bradley A., Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
Introduction

Fluid overload is a significant risk factor for morbidity and mortality in patients receiving CRRT. Records of fluid balance, clinical signs of fluid overload (weight, peripheral edema), hemodynamic parameters (tachycardia, blood pressure), filling pressure (CVP), bioelectrical impedance, and radiological studies (CXR, IVC diameter) are the clinical tools that are commonly utilized to help assess volume status, each of which has their own limitations.
The aminoterminal fragment of B-type natriuretic peptides (NTproBNP), a biologically inert molecule with half-life of 60-120 min produced from left ventricular myocardium, is well established as a good diagnostic and prognostic indicator of heart failure.
Our previous observation of a correlation of NTproBNP with volume status in an infant without cardiac disease who received CRRT led us to use NTproBNP as a surrogate marker of volume status in a newborn currently receiving prolonged CRRT.

Case Description

NTproBNP levels were measured at least twice a week in a 4-month-old anephric (status post bilateral nephrectomy for ARPKD) infant receiving CRRT (clearance 30 – 35 mL/kg/hr). NTproBNP levels were correlated with weight (used as surrogate for volume status), and clinical evidence of cardiorespiratory compromise.
Over a period of 47 continuous days on CRRT, 40 NTproBNP values were obtained. The weights ranged from 3.60 kg to 4.88 kg, while the NTproBNP values ranged from 396 to 92,300 pg/mL. There was a significant correlation between patient weight and NTproBNP levels (r = 0.57; p < 0.001) which helped guide the patient’s fluid management. The relationship between patient weight, NTproBNP level and clinical status is shown in the figure.

Discussion

NTproBNP may be able to be used as a reliable complementary marker for volume status in a select (without underlying cardiac disease) group of pediatric patients receiving prolonged CRRT. Further study is required to validate the findings in a cohort of patients.