title: Prohormone brain natriuretic peptide (proBNP), BNP and N-terminal-proBNP circulating levels in chronic hemodialysis patients. Correlation with ventricular function, fluid removal and effect of hemodiafiltration.
abstract: BACKGROUND
  Brain natriuretic peptide (BNP), N-terminal proBNP (NT-proBNP) and to a lesser extent prohormone proBNP are recognized as biochemical markers of left ventricular dysfunction. In renal failure, interpretation of natriuretic peptide remains unclear, as natriuretic peptide levels may be not only be dependent on cardiac function and dimensions but also on renal function, fluid volume and removal by dialysis procedure including hemodiafiltration (HDF). The purpose of this study was (i) to assess BNP, NT-proBNP and proBNP levels and their correlation with clinical and echocardiographic data in chronic hemodialysis patients, and (ii) to investigate basal level alteration following HDF.
  
  
  METHODS
  Baseline clinical and echocardiographic parameters were collected in 31 dialysis patients without evidence of cardiac failure. Pre- and post-HDF BNP, NT-proBNP and proBNP concentrations were measured. Correlations between echocardiographic measurements and basal circulating peptides, between changes in peptide values and changes in fluid volume after HDF were investigated.
  
  
  RESULTS
  Baseline plasmatic levels were elevated (BNP=517+/-840 pg/mL, NT-proBNP=5340+/-6132 pg/mL and proBNP=3569+/-4683 pg/mL) and correlated with left auricular diameter and left ventricular mass index. HDF session induced a significant decrease of 39%, 59% and 36% for BNP, NT-proBNP and proBNP levels, respectively. This decrease was not correlated to post-HDF fluid removal or weight decrease. Correlation between BNP and proBNP was stronger (r(2)=0.88) than between NT-proBNP and proBNP (r(2)=0.54).
  
  
  CONCLUSIONS
  Despite their elimination, BNP, NT-proBNP and proBNP could be potential markers of left ventricular remodeling in chronic renal failure patients on hemodialysis. According to these results, their cut-off values, however, need to be re-evaluated.
authors.affiliation: Laboratoire de Biochimie, CHU Lapeyronie, Université Montpellier 1, Montpellier, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Bargnoux
authors.forename: Kada
authors.initials: K
authors.lastname: Klouche
authors.forename: Jeanette
authors.initials: J
authors.lastname: Fareh
authors.forename: Isabelle
authors.initials: I
authors.lastname: Barazer
authors.forename: Sylvie
authors.initials: S
authors.lastname: Villard-Saussine
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Dupuy
authors.forename: Hélène
authors.initials: H
authors.lastname: Leray-Moragues
authors.forename: Isabelle
authors.initials: I
authors.lastname: Giuliani
authors.forename: Bernard
authors.initials: B
authors.lastname: Canaud
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Cristol
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis; D017583:Hemodiafiltration; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D006435:Renal Dialysis; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain