Abstract
BackgroundPlasma BNP levels are predictive of prognosis in hemodialysis patients. However, recent studies showed that the current BNP immunoassay cross-reacts with glycosylated proBNP, and the NT-proBNP assay underestimates glycosylated NT-proBNP. In addition, the recently developed high performance dialyzer removes medium-sized molecular solutes such as β2-microgloburin. We therefore investigated the effects of high performance dialysis on measured levels of glycosylated proBNP, glycosylated NT-proBNP and other BNP-related peptides in end-stage renal disease (ESRD) patients on hemodialysis.MethodThe relationships between clinical parameters and BNP-related molecule were also investigated. We used our newly developed immunoassay to measure plasma total BNP and proBNP in 105 normal subjects and 36 ESRD patients before and after hemodialysis. Plasma NT-proBNP was measured using Elecsys II after treatment with or without deglycosylating enzymes. We also measured plasma ANP and cGMP using radioimmunoassays.ResultsAll the measured BNP-related peptides were significantly higher in ESRD patients than healthy subjects. Total BNP (−38.9%), proBNP (−29.7%), glycoNT-proBNP (−45.5%), nonglycoNT-proBNP (−53.4%), ANP (−50.4%) and cGMP (−72.1%) were all significantly reduced after hemodialysis, and the magnitude of the reduction appeared molecular weight- dependent. Both the proBNP/total BNP and glycoNT-proBNP/nonglycoNT-proBNP ratios were increased after hemodialysis. The former correlated positively with hemodialysis vintage and negatively with systolic blood pressure, while the latter correlated positively with parathyroid hormone levels.ConclusionThese results suggest that hemodialysis using super-flux dialyzer removes BNP-related peptides in a nearly molecular weight-dependent manner. The ProBNP/total BNP and glycoNT-proBNP/nonglycoNT-proBNP ratios appear to be influenced by hemodialysis-related parameters in ESRD patients on hemodialysis.
Highlights
Hemodialysis patients exhibit a greatly heightened risk of cardiovascular morbidity and mortality
Total B-type natriuretic peptide (BNP) (238.9%), Pro-B-Type Natriuretic Peptide (proBNP) (229.7%), glycoNT-proBNP (245.5%), nonglycoNT-proBNP (253.4%), atrial natriuretic peptide (ANP) (250.4%) and cGMP (272.1%) were all significantly reduced after hemodialysis, and the magnitude of the reduction appeared molecular weightdependent
The ProBNP/total BNP and glycoNT-proBNP/nonglycoNT-proBNP ratios appear to be influenced by hemodialysis-related parameters in end-stage renal disease (ESRD) patients on hemodialysis
Summary
Hemodialysis patients exhibit a greatly heightened risk of cardiovascular morbidity and mortality. These patients experience an extremely high prevalence of left ventricular hypertrophy and heart failure. Plasma levels of BNP, NT-proBNP and ANP are elevated in patients with cardiac hypertrophy or heart failure. Even in dialysis patients with end-stage renal disease (ESRD), BNP is used for diagnosis and evaluation of the severity of heart failure and is predictive of patient prognosis. Plasma BNP levels are predictive of prognosis in hemodialysis patients. We investigated the effects of high performance dialysis on measured levels of glycosylated proBNP, glycosylated NT-proBNP and other BNP-related peptides in end-stage renal disease (ESRD) patients on hemodialysis
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