B-type Natriuretic Peptide Dialysis Clearance and Renal Function in Patients with Decompensated Heart Failure
Article Outline
To the Editor:
Vickery et al1 found an inverse correlation between plasma B-type natriuretic peptide (BNP) concentration and estimated glomerular filtration rate in patients with chronic kidney disease. Congestive heart failure (CHF) often is associated with progressive deterioration in renal function and unresponsiveness to diuretic treatment, encouraging toward such new therapeutic strategies as continuous ultrafiltration.2 Wahl et al3 showed that BNP is removed effectively during hemodialysis. We tested the hypothesis that effective dialysis BNP removal in patients with decompensated CHF unresponsive to diuretic treatment results in an improvement in renal function and, consequently, furosemide diuresis restoration. Five consecutive patients with a mean age of 57 ± 12 (SD) years with decompensated CHF unresponsive to diuretic treatment (New York Heart Association classes III to IV) were enrolled prospectively. All 5 patients underwent a short course of hemodiafiltration (HDF) using an AN-69 membrane (M100; Hospal, Italy) with a surface area of 1 m2. Mean duration of a single HDF session was 220 ± 49 minutes for 4 ± 1.6 sessions. Excess body fluid was removed (Table 1), always resulting in a decrease in pulmonary congestion and peripheral edema. New York Heart Association class improved in all patients. One month after the last HDF session, plasma BNP levels were significantly decreased, but renal function was stable and did not improve significantly (Table 1). Our data suggest that excess body fluid removal and general improvement in the clinical picture, but not BNP level decrease by means of HDF, might overcome the endogenous resistance to BNP present in patients with CHF recovering natriuresis and maintaining stable renal function.
Table 1. Clinical and Laboratory Findings in Patients With CHF Unresponsive to Diuretic Treatment Treated With HDF
| Patients With CHF (N = 5) | ||
|---|---|---|
| Basal | 1-Mo Follow-Up | |
| Weight (kg) | 76.8 ±6.1 | 67.1±5.7⁎ |
| Furosemide (oral; mg/d) | 180±80 | 75±38⁎ |
| Plasma creatinine (mg/dL) | 1.9±1.6 | 1.6±0.4 |
| BNP (pg/mL) | 706±257 | 248±152⁎ |
⁎ P < 0.05 versus basal. |
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References
- B-Type natriuretic peptide (BNP) and amino-terminal proBNP in patients with CKD (Relationship to renal function and left ventricular hypertrophy) . Am J Kidney Dis . 2005;46:610–620
- . Extracorporeal ultrafiltration for the treatment of overhydration and congestive heart failure . Cardiology . 2001;96:155–168
- . Elimination of the cardiac natriuretic peptides B-type natriuretic peptide (BNP) and N-terminal proBNP by hemodialysis . Clin Chem . 2004;50:1071–1074
Editor Note: The corresponding author did not respond.Support: An Italian Ministry of Health grant supported this work.
PII: S0272-6386(06)00002-3
doi:10.1053/j.ajkd.2005.11.032
© 2006 National Kidney Foundation, Inc. Published by Elsevier Inc All rights reserved.
