Abstract
Natriuretic peptides, brain natriuretic peptide (BNP), and N-terminal probrain natriuretic peptide (NT-proBNP) are mainly known as diagnostic markers for heart failure with high diagnostic and prognostic values in the general population. In patients who are undergoing hemodialysis (HD), changes in NT-proBNP can be related to noncardiac problems such as fluid overload, inflammation, or malnutrition and can also be influenced by the dialysis characteristics. The current review aimed to summarize findings from studies on the association between NT-proBNP and malnutrition in HD patients. Articles published after 2009 and over a ten-year period were considered for inclusion. We first briefly discuss the traditional functions of NT-proBNP, and after, we describe the functions of this prohormone by focusing on its relation with protein energy wasting (PEW) in HD patients. Mechanisms that could explain these relationships were also discussed. Overall, 7 studies in which the investigation of the relations between NT-proBNP and nutritional status in HD patients were among the main objects were taken into account. NT-proBNP levels correlated with several factors described in the 4 categories of markers indicative of PEW (body mass and composition, muscle mass, biochemical criteria, and dietary intakes) and/or were associated with PEW. Interactions between several parameters could be involved in the association between NT-proBNP and malnutrition with a strong role of weight status. NT-proBNP is elevated in HD patients and is associated with malnutrition. Nevertheless, the prognostic value of NT-proBNP on nutritional status should be evaluated.
Highlights
IntroductionCalled malnutrition inflammation complex syndrome or protein energy wasting, corresponding to a decrease in energy and body protein, is a common problem in patients with end-stage renal disease (ESRD) undergoing HD and has been consistently associated with mortality in different populations [1,2,3,4,5].Brain natriuretic peptide (BNP) is synthesized mainly in the heart as a proBNP that is further cleaved into bioactive BNP and biologically inactive NT-proBNP [6].Both BNP and NT-proBNP are released in response to changes in pressure inside the heart that are related to heart failure and other cardiac problems. us, BNP and NT-proBNP are mainly known as cardiac biomarkers with high diagnostic and prognostic values [7,8,9] with widespread use in cardiac diseases [10]
Both Brain natriuretic peptide (BNP) and NT-proBNP are released in response to changes in pressure inside the heart that are related to heart failure and other cardiac problems. us, BNP and NT-proBNP are mainly known as cardiac biomarkers with high diagnostic and prognostic values [7,8,9] with widespread use in cardiac diseases [10]
Studies on maintenance of HD patients have reported the association between NTproBNP levels and malnutrition by subjective global assessment (SGA), malnutrition-inflammation score (MIS), or markers defined in the International Society of Renal Nutrition and Metabolism (ISRNM) nomenclature [11,12,13,14,15,16,17]
Summary
Called malnutrition inflammation complex syndrome or protein energy wasting, corresponding to a decrease in energy and body protein, is a common problem in patients with end-stage renal disease (ESRD) undergoing HD and has been consistently associated with mortality in different populations [1,2,3,4,5].Brain natriuretic peptide (BNP) is synthesized mainly in the heart as a proBNP that is further cleaved into bioactive BNP and biologically inactive NT-proBNP [6].Both BNP and NT-proBNP are released in response to changes in pressure inside the heart that are related to heart failure and other cardiac problems. us, BNP and NT-proBNP are mainly known as cardiac biomarkers with high diagnostic and prognostic values [7,8,9] with widespread use in cardiac diseases [10]. Brain natriuretic peptide (BNP) is synthesized mainly in the heart as a proBNP that is further cleaved into bioactive BNP and biologically inactive NT-proBNP [6]. Both BNP and NT-proBNP are released in response to changes in pressure inside the heart that are related to heart failure and other cardiac problems. In HD patients, changes in NT-proBNP can be related to noncardiac problems such as fluid overload, inflammation, or malnutrition In this line, NT-proBNP was recently associated with 2-year mortality from both cardiovascular and noncardiovascular origins in 1,310 prevalent chronic HD patients [3].
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