Two daytime icodextrin exchanges decrease brain natriuretic peptide levels and improve cardiac functions in continuous ambulatory peritoneal dialysis patients.
OBJECTIVE
Peritoneal dialysis patients with ultrafiltration failure frequently have fluid overload. It is known that the increase in the ultrafiltration is associated with decrease in the left ventricle (LV) dysfunction. This study was designed to examine the potential effects of serum brain natriuretic peptide (BNP) on cardiac functions and to determine the relationship between BNP and cardiac parameters in continuous ambulatory peritoneal dialysis (CAPD) patients with ultrafiltration failure.


METHODS
Twenty-eight patients with high or high-average membrane permeability as indicated by the peritoneal equilibration test were enrolled and randomized to receive either once or twice daily icodextrin. Serum BNP levels and echocardiographic measurements were evaluated at baseline and at the end of the eighth week. The correlations between the percentage changes of parameters from baseline were also studied.


RESULTS
In both groups there was a significant decrease in serum BNP, LV mass, heart rate (HR) and cardiothoracic index (CTI) and an improvement in ejection fraction (all P < 0.05). However, the percentage of change in all these parameters was significantly better in the twice daily compared with once daily group (all P < 0.05). Furthermore, the percentage decrease in BNP was positively correlated with the percentage decrease in HR, LV mass and BP.


CONCLUSIONS
Twice daily icodextrin treatment might be useful in hypervolaemic CAPD patients for the improvement of cardiac functions. BNP monitoring may be useful to follow up these patients.
Sav
Tansu
T
Department of Nephrology, Kayseri State Hospital, Kayseri, Turkey. savtansu@gmail.com
Inanc
Mehmet Tugrul
MT
Dogan
Ali
A
Oymak
Oktay
O
Utas
Cengiz
C
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D015536:Down-Regulation; D004452:Echocardiography; D005260:Female; D005936:Glucans / Q000008:administration & dosage*; D005947:Glucose / Q000008:administration & dosage*; D006339:Heart Rate; D015312:Hemodialysis Solutions / Q000008:administration & dosage*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D000077607:Icodextrin; D007674:Kidney Diseases / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects; D011446:Prospective Studies; D020127:Recovery of Function; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left; D055815:Young Adult
D015415:Biomarkers; D005936:Glucans; D015312:Hemodialysis Solutions; D020097:Natriuretic Peptide, Brain; D000077607:Icodextrin; D005947:Glucose