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ISSN: 1734-1922
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Is N-terminal pro-brain natriuretic peptide a reliable marker for body fluid status in children with chronic kidney disease?

Hulya Nalcacioglu
Ozan Ozkaya
Hasan C. Kafali
Demet Tekcan
Bahattin Avci
Kemal Baysal

Online publish date: 2019/06/03
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Brain natriuretic peptides, released in response to left ventricular stress, have a strong prognostic value in dialysis patients. However, their role in detecting abnormalities of fluid status is under debate; the relationship between volume status and brain natriuretic peptide s (BNPs) differs among various studies. The aim of our study was to evaluate the clinical utility of N-terminal proBNP in the assessment of fluid status and cardiovascular risk in this setting.

Material and methods
The study included 65 children: 10 pre-dialysis, 13 hemodialysis, 12 peritoneal dialysis patients and 30 healthy controls. Volume status was determined by multifrequency bioimpedance and NT-proBNP, as well as echocardiography to estimate the left ventricle structure and function.

The median log NT-proBNP values of hemodialysis and peritoneal dialysis patients were 3.66 (2.05–4.90) and 3.57 (2.51–4.13) pg/ml, respectively, and significantly higher compared with the control group (p < 0.001, p < 0.001). On simple correlation, NT-proBNP was correlated with markers of volume overload and cardiac dysfunction. On multivariate regression analysis, only left ventricle mass index ( = 0.402, p = 0.003) and left atrium diameter ( = 0.263, p = 0.018) were independently associated with NT-proBNP (adjusted R2 of the model: 0.707, p < 0.001).

Our research suggested that NT-proBNP, which was correlated with LV systolic and diastolic dysfunction and fluid overload as assessed by bioimpedance, can be used to evaluate cardiovascular states in a chronic kidney disease (CKD) population. From the early stages of CKD, periodic monitoring of NT-proBNP levels may be essential for early detection of patients with high risk of cardiovascular events, and for taking preventive intervention as soon as possible.


chronic kidney disease, pediatrics, bioimpedance analysis, volume status, N-terminal pro-brain natriuretic peptide

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