The role of natriuretic peptides in volume assessment and mortality prediction in Haemodialysis XXXX .

@entity1 @entity4 @entity3876
BACKGROUND: Maintaining optimal fluid balance is essential in haemodialysis (HD) @entity1 but clinical evaluation remains problematic. Other technologies such as bioimpedance are emerging as valuable adjuncts. This study was undertaken to explore the potential utility of the natriuretic peptides - atrial natriuretic peptide (ANP) and @entity3876 ( @entity3876 ) in the assessment of fluid status and cardiovascular risk in this setting. METHODS: This was a cross-sectional study carried out in an unselected cohort of 170 prevalent HD @entity1 . Volume status was assessed by clinical parameters - the presence or absence of peripheral @entity4 , raised jugular venous pressure and basal lung crepitations; by extracellular fluid volume (ECFV) status determined by whole body bioimpedance; and by serum levels of @entity3876 and ANP (pre- and post -dialysis). The relationships of ANP and @entity3876 levels to clinical and bioimpedance parameters of volume status was determined. @entity1 were followed up for 5  years to assess the relationship of natriuretic peptide levels to mortality. RESULTS: Bioimpedance estimates of ECFV expansion (>105  % of ideal ECFV) was present in 52  % of @entity1 pre-dialysis. A significant proportion (21  %) of pre-dialysis @entity1 had a depleted ECFV (<95  % of ideal ECFV) pre-dialysis. The situation was reversed post-dialysis. A raised JVP >3  cm was the most reliable clinical sign of ECFV expansion inferred from bioimpedance measurements and natriuretic peptide levels. The vast majority of @entity1 with this sign also had lung crepitations or peripheral @entity4 or both. @entity3876 was a stronger predictor of ECFV expansion than either pre- or post-dialysis ANP. @entity3876 was also a stronger predictor of five-year survival. CONCLUSION: Serum levels of @entity3876 have a strong relationship to both volume status and survival in HD @entity1 . We found no clear role for measurement of ANP, though changes in blood levels may be a sensitive indicator of acute changes in volume status. Whether monitoring levels of these peptides has a role in the management of volume status and cardiovascular risk requires further study.
