Abstract: PUB094
Effect of Volume Removal by Hemodialysis on Elevated N-Terminal Pro Brain-Type Natriuretic Peptide (NT-ProBNP) Level
Session Information
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Tinawi, Mohammad, Nephrology Specialists PC, Gary, Indiana, United States
- Bastani, Bahar, Saint Louis University, Saint Louis, Missouri, United States
Background
N-Terminal pro brain-type natriuretic peptide (NT-proBNP) is highly sensitive and specific for the diagnosis of congestive heart failure (CHF). Nearly all end-stage kidney disease (ESKD) patients on renal replacement therapy have an elevated NT- proBNP plasma level. Measurements of NT-proBNP before and after hemodialysis (HD) in patients who are hospitalized with volume expansion is a common practice. The purpose of this study is to determine the clinical value of repeated NT-proBNP measurements in patients with ESKD or acute kidney injury (AKI) requiring HD, and to study the effect of volume removal via HD on NT-proBNP level.
Methods
We conducted a retrospective analysis of patients admitted to two community hospitals over a 3-year period (Jan/2020-Dec/2022). Patients with AKI requiring HD or ESKD were screened if they had an admission diagnosis of volume expansion including acute CHF or pulmonary edema that was verified radiographically and by physical examination.
Patients with an admission NT-proBNP level and a repeat level 2 to 12 hours after HD were included. Over the 3-year period, 36 patients with ESKD and 5 patients with AKI requiring HD fulfilled the inclusion criteria.
Results
Volume removal via HD had no impact on NT-proBNP levels in ESKD or AKI patients (ESKD P= 0.7858; AKI P=0.6903). Our patients had significantly elevated NT-proBNP due to renal dysfunction and volume expansion. The table below summarizes our main findings.
Conclusion
While identifying acute or chronic HD patients with volume expansion and significant elevation in NT-proBNP to intensify their cardiovascular management may be beneficial, measuring NT-proBNP level after a single HD session to document a positive effect of volume removal is of no clinical value. Our data suggest that NT-proBNP is a useful cardiac biomarker for volume expansion and its elevated level predict high cardiovascular mortality and recurrent hospitalizations in acute and chronic HD patients.
| ESKD (n=36) | AKI (n=5) | |
| Duration of HD in hours (Mean, range) | 3.3 (2.5-4) | 2.8 (2.5-3) |
| Volume removal in liters (Mean, range) | 2.5 (1-5) | 1.3 (1-2) |
| Number of hospitalizations post initial presentation during the study period (Median, range) | 3.0 (0-14) | 1 (0-3) |
| Mortality over the study period (%) | 30 | 60 |
| Pre-HD NT-Pro BNP (pg/ml) (Mean ± SD, range) NT-proBNP calibration range 5 to 35,000 pg/mL | 29,151±10,039 (4,113-35,000) | 25,823±12,271 (4,270-35,000) |
| Post-HD NT-Pro BNP (pg/ml) (Mean ± SD, range) | 28,980±9,815 (4,440-35,000) | 26,523±11,339 (4,736-35,000) |