Strict volume control and longitudinal changes in cardiac biomarker levels in hemodialysis patients.
BACKGROUND
Our aim was to analyze the longitudinal changes in cardiac biomarker levels in hemodialysis patients with high comorbidity treated in our special hospital unit. We hypothesize that strict volume control strategy (salt-restricted diet, extended dialysis sessions and dry weight clinical assessment and reassessment in every session) could prevent progression of left-ventricular damage and, therefore, progressive increment in cardiac biomarker levels over time.


METHODS
This is a longitudinal cohort study including 46 dialysis patients in which a strategy of strict volume control has been adopted. N-terminal pro-B-type natriuretic peptide (NT-proBNP), troponin T and C-reactive protein (CRP) levels were measured at baseline and prospectively at 4, 8 and 12 months. The possible association between volume control and cardiac biomarker levels was analyzed.


RESULTS
Dry weight could be reduced (p < 0.01) over time. A reduction in systolic BP (p < 0.05) and in CRP levels (p < 0.05) was observed, whereas NT-proBNP and troponin T values remained stable. However, patients in the high quartile of NT-proBNP at baseline showed a reduction (p = 0.02) in troponin T over time with no significant trend (p = 0.08) to progressive reduction in NT-proBNP values.


CONCLUSIONS
Strict volume control in dialysis patients may prevent progressive increment in cardiac biomarker levels over time. The impact seems to be higher among patients with higher levels at baseline in whom strict volume control can even reduce cardiac biomarker levels on follow-up.
Ortega
Olimpia
O
Nephrology Service, Hospital Severo Ochoa, Leganes, Spain. oortega.hsvo@salud.madrid.org
Rodriguez
Isabel
I
Gracia
Carolina
C
Sanchez
María
M
Lentisco
Carolina
C
Mon
Carmen
C
Gallar
Paloma
P
Ortiz
Milagros
M
Herrero
Juan Carlos
JC
Oliet
Aniana
A
Vigil
Ana
A
D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000534:rehabilitation*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; D006435:Renal Dialysis / Q000379:methods*; D017582:Renal Replacement Therapy / Q000379:methods*; D020107:Troponin T; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000209:etiology / Q000517:prevention & control*
D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein