NT-proBNP and troponin T levels differ after haemodialysis with a low versus high flux membrane.
BACKGROUND
Brain natriuretic peptide (BNP), N-terminal-proBNP (NT-proBNP), and high sensitive cardiac troponin T (TnT) are markers that are elevated in chronic kidney disease and correlate with increased risk of mortality. Data are conflicting on the effect of biomarker levels by hemodialysis (HD).Our aim was to clarify to what extent HD with low-flux (LF) versus high-flux (HF) membranes affects the plasma levels of BNP, NT-proBNP, and TnT.


METHODS
31 HD patients were included in a crossover design, randomized to start dialysis with a LF-HD or HF-HD dialyzer. Each patient was his/her own control. The dialyses included in the study were the first treatments of two consecutive weeks with each mode of dialysis. Patients normally on hemodiafiltration (HDF) also performed a HDF the third week. Values after HD were corrected for extent of ultrafiltration.


RESULTS
During LF-HD the biomarkers NT-proBNP and TnT increased (15 versus 6%, P ≤ .001) while there was a slight decrease in BNP (P<.05). During HF-HD the NT-proBNP, BNP and TnT levels decreased (P ≤ .01 for all). During HDF all three markers decreased (P<.01 for all). The rise in TnT during LF-HD correlated with dialysis vintage (months on HD, r = .407, P = .026), Kt/V-urea (r = .383, P = .037), HD time in hours/treatment (r = .447, P = .013) and inversely with residual urinary output (r = -.495, P = .005). The baseline levels of BNP and NT-proBNP correlated with blood pressure.


CONCLUSIONS
Cardiac biomarkers increase slightly during LF-HD. A HF-HD eliminates the biomarkers and can mask increases caused by, e.g., myocardial infarction.
Department of Public Health and Clinical Medicine, Umea University, Umea - Sweden.
Emilie
E
Laveborn
Krister
K
Lindmark
Malin
M
Skagerlind
Bernd
B
Stegmayr
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D018592:Cross-Over Studies; D004867:Equipment Design; D005260:Female; D006331:Heart Diseases / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D008567:Membranes, Artificial; D010446:Peptide Fragments; C545568:TNNT2 protein, human; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain