title: B-type natriuretic peptide-directed ultrafiltration improves care in acutely hospitalized dialysis patients.
abstract: In an observational study in 19 consecutive acutely hospitalized dialysis patients, ultrafiltration (UF) volume was determined by B-type natriuretic peptide (BNP) levels. Patients were ultrafiltrated daily until they achieved a target BNP level <500 pg/mL. The UF volumes ranged from 2 to 5 L per session. All patients were male veterans aged 68+/-11 years (mean +/- SD), 74% were diabetic, 47% were African Americans, 58% underwent prevalent dialysis, and 53% had an arteriovenous fistula. Left ventricular ejection fraction on 2-dimensional echocardiography was 43.8%+/-27.9% (n=16). The admission BNP was 2412+/-1479 pg/mL (range, 561-5000 pg/mL) and BNP at hospital discharge was 1245+/-1173 pg/mL (range, 345-5000 pg/mL) (nonparametric Wilcoxon P=.0013). Admission weight was 88.9+/-27.9 kg and at discharge was 78.1+/-25.6 kg (P=.0002). The number of antihypertensive medications taken was 3.8+/-2.0 at admission and 2.3+/-1.7 at discharge (P=.0005). The number of patients with >2 blood pressure medications decreased from 14 to 6 (Fisher exact test, P=.02). The systolic/diastolic/mean arterial blood pressure decreased from admission to discharge (153.6+/-43.8/80.6+/-21.8/102.4+/-27.3 to 132.1+/-27.9/68.9+/-14.6/89.9+/-16.5 mm Hg; P=.0222/.0139/.0329, respectively). Although all patients were volume-overloaded at admission according to BNP criteria (>500), only 42% were identified as having heart failure. BNP-directed UF is safe because it minimizes symptomatic hypotension, identifies occult congestive heart failure in a large number of patients, and significantly reduces blood pressure in addition to reducing body weight and number of medications used.
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Louisiana State University Health Sciences Center, 501 Kings Highway, Shreveport, LA, USA. mtapolyai@aol.com
authors.forename: Mihály
authors.initials: M
authors.lastname: Tapolyai
authors.forename: Aşkin
authors.initials: A
authors.lastname: Uysal
authors.forename: Gail
authors.initials: G
authors.lastname: Maeweathers
authors.forename: Elias
authors.initials: E
authors.lastname: Bahta
authors.forename: Neville R
authors.initials: NR
authors.lastname: Dossabhoy
mesh_terms: D000208:Acute Disease; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001810:Blood Volume; D005240:Feasibility Studies; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D017583:Hemodiafiltration / Q000379:methods* / Q000592:standards; D006760:Hospitalization; D006787:Hospitals, Veterans; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D005791:Patient Care / Q000592:standards; D010865:Pilot Projects; D011446:Prospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left
chemical_list: D000959:Antihypertensive Agents; D020097:Natriuretic Peptide, Brain