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Creation of dialysis vascular access with normal flow increases brain natriuretic peptide levels

  • Nephrology - Original Paper
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Abstract

Background

Chronic heart failure is very common in hemodialyzed patients due to several factors such as intermittent volume overload, anemia, and hypertension. Dialysis access flow is usually considered to have a minor effect. We hypothesized that creation of dialysis access with “normal” flow would lead to elevation of B-type natriuretic peptide (BNP), which is a sensitive marker of heart failure.

Methods

We included subjects with a newly created, well-functioning vascular access and normal left ventricular ejection fraction. They were examined before access creation (baseline), then again 6 weeks and 6 months after the surgery. Only subjects with access flow (Qa) < 1500 ml/min were included. Changes of BNP levels and their relation to access flow were studied.

Results

We examined 35 subjects aged 60.6 ± 13.5 years. Qa was 789 ± 361 and 823 ± 313 ml/min at 6 weeks and 6 months after the surgery, respectively. Within 6 weeks after access creation, BNP rose from 217 (294) to 267 (550) ng/l (median (quartile range)) with P = 0.003. Qa was significantly related to BNP levels 6 weeks after access creation (r = 0.37, P = 0.036). Six months after access creation, there was only a trend of BNP decrease (235 (308) ng/l, P = 0.44). Creatinine, blood urea nitrogen and hemoglobin levels as well as patients’ weight did not change significantly.

Conclusions

Creation of dialysis access with “normal” flow volume leads to significant increase of BNP, which is related to the value of access flow. The increase of BNP probably mirrors worsening of clinically silent heart failure.

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Acknowledgments

The study was supported by the grant NR 8334 of Internal Grant Agency, Ministry of Health, Czech Republic.

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Authors and Affiliations

  1. Third Department of Internal Medicine, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czech Republic

    Jan Malík, Vladimir Tuka, Zdislava Krupickova, Eva Chytilova & Robert Holaj

  2. Department of Cardiovascular Surgery, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czech Republic

    Marcela Slavikova

  3. U nemocnice 1, 12808, Prague 2, Czech Republic

    Jan Malík

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  1. Jan Malík
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  2. Vladimir Tuka
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  3. Zdislava Krupickova
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  4. Eva Chytilova
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  5. Robert Holaj
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  6. Marcela Slavikova
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Correspondence to Jan Malík.

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Malík, J., Tuka, V., Krupickova, Z. et al. Creation of dialysis vascular access with normal flow increases brain natriuretic peptide levels. Int Urol Nephrol 41, 997–1002 (2009). https://doi.org/10.1007/s11255-009-9544-y

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  • DOI: https://doi.org/10.1007/s11255-009-9544-y

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