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Kinetics of atrial and brain natriuretic peptides during hemodialysis are regulated in association with different cardiac functional changes

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Abstract

The blood levels of atrial and brain natriuretic peptides (ANP and BNP) are both increased markedly in hemodialysis patients, but the kinetics of the two are not always parallel. The present study investigated the association of changes in ANP and BNP levels before and after dialysis with changes in cardiac function in hemodialysis patients. A total of 57 patients (mean age 64 years, 47 males and 10 females) on maintenance hemodialysis with sinus rhythm were enrolled. Blood samples were taken at the beginning and end of dialysis, and plasma levels of ANP and BNP were measured. Changes in cardiac function during dialysis were examined by echocardiography performed just before and after dialysis. Both plasma ANP and BNP concentrations decreased significantly after hemodialysis, but the rate of decrease in BNP [mean ± SD, 555 ± 503 to 519 ± 477 pg/mL (− 6.4%), P = 0.011] was much smaller than that in ANP [233 ± 123 to 132 ± 83 pg/mL (− 43.4%), P < 0.001]. As for the relation to the changes in echocardiographic parameters before and after dialysis, the decrease in inferior vena cava diameter had a close correlation with the decrease in ANP (r = 0.528, P < 0.001), but not BNP. In contrast, the decrease in left ventricular end-diastolic volume index was correlated only with the decrease in BNP (r = 0.297, P = 0.035). The peak velocity ratio of early diastolic to atrial filling decreased with preload reduction by dialysis, and its decrease was more strongly correlated with the decrease in BNP (r = 0.407, P = 0.002) than that in ANP (r = 0.273, P = 0.040). These results demonstrated that in hemodialysis patients, the decrease in plasma ANP by a single dialysis was essentially caused by blood volume reduction, while BNP decrease was mainly induced by the reduction of left ventricular overload. Our findings indicate that the kinetics of both peptides during dialysis are regulated by different cardiac and hemodynamic factors.

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Acknowledgements

The authors thank Yoko Saito (Education and Research Center, Ishikiriseiki Hospital) for assistance with collecting patient clinical data.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Ishikiriseiki Hospital, 18-28 Yayoi-cho, Higashiosaka, 579-8026, Japan

    Takeshi Horio & Kohei Fujimoto

  2. Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan

    Shogo Ito, Yasuhiro Izumiya & Minoru Yoshiyama

  3. Department of Nephrology and Hypertension, Dokkyo Medical University, Mibu, Japan

    Yoshio Iwashima

  4. Department of Nutritional Sciences for Well-Being, Kansai University of Welfare Sciences, Kashiwara, Japan

    Satoko Nakamura

  5. Division of Nephrology and Hypertension, National Cerebral and Cardiovascular Center, Suita, Japan

    Fumiki Yoshihara

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  1. Takeshi Horio
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  2. Shogo Ito
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  3. Kohei Fujimoto
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  4. Yasuhiro Izumiya
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  6. Yoshio Iwashima
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  8. Fumiki Yoshihara
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Correspondence to Takeshi Horio.

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Horio, T., Ito, S., Fujimoto, K. et al. Kinetics of atrial and brain natriuretic peptides during hemodialysis are regulated in association with different cardiac functional changes. Heart Vessels 37, 1146–1152 (2022). https://doi.org/10.1007/s00380-021-02011-w

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