An Impact of
an Acute Fluid Restriction on Levels of Natriuretic Peptides in Patients on Chronic Dialysis
Program
Oral I.1, Stejskal D.2, Loucký J.3, Šišlák Z.1, Coufal Z.1, Mistrík J.1, Náplava R.1
1Interní klinika IPVZ, Baťova krajská nemocnice, Zlín, přednosta prim. MUDr. Ivo Oral, CSc.2OLM nemocnice Šternberk, přednosta prim. MUDr. David Stejskal 3IMALAB Zlín, přednosta prim. RNDr. Jaroslav Loucký |
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Summary:
In order to assess an impact of acute changes in blood volume on levels of B-type natriuretic
peptides (BNP and NT-proBNP) 30 patients with a heart disease and chronic renal insufficiency
on chronic dialysis program were assessed. An acute fluid restriction of 3750 ml on an average
lead to decreased filling of the left heart ventricle (echocardiography revealed a reduced size of
the left atrium, change in E/A parameters and deceleration time, and decreased end-diastolic
volume of the left ventricle). Prior to dialysis normal levels of BNP (2.58 ± 1.21 pg/ml) and elevated
levels of NT-proBNP (193.2 ± 117.7 pg/ml) had been indicated. Following dialysis a statistically
significant decrease of BNP concentration in venous blood was proved, however it was “masked”
by hemoconcentration. NT-proBNP level in venous blood remained unchanged. Correlation between
BNP and NT-proBNP was not proved before dialysis nor after it. Correlation between BNP
levels and echocardiographic parameters was not confirmed and a weak negative correlation
with ejection fraction was proved in NT-proBNP. A BNP assessment could play an important role
in the evaluation of acute changes in heart compensation. On the other way, NT-proBNP concentration
is stable and is a long term marker of synchronisation of fluid circulation and function of
the left ventricle. An importance of its assessment is probably rather prognostic.
Key words:
B-type natriuretic peptides, NT-proBNP - BNP - Laboratory diagnostics in cardiology -
Dialysis
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