Influence of Cardiac Diseases on Plasma Brain Natriuretic Peptide Level in Chronic Hemodialysis and Kidney Transplantation Patients
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- Category: Vol. 84, December 2016
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Influence of Cardiac Diseases on Plasma Brain Natriuretic Peptide Level in Chronic Hemodialysis and Kidney Transplantation Patients, RASHA A. DARWISH, MOHAMED A. HUSSEIN, ALAA M. ABD EL-HAMID, EMAN F. RAMZY and MOHAMED H. HAFEZ
Abstract
Background and Objectives: The N Terminal of pro Brain Natriuretic Peptide (NT-pro BNP) is an important biomarker in prognostication and risk stratification of Cardiovascular Disease (CVD) and is significantly associated with decreased Glomerular Filtration Rate (GFR) and Chronic Kidney Disease (CKD) but with insufficient data to establish clear cut off values. In this work, we aimed to find a correlation between plasma NT-pro BNP levels and parameters of echocardiography with establishing of clear cut off values in this setting.
Patients and Methods: Serum NT pro BNP {in pictograms per milliliter (pg/ml)} was measured in 20 patients on Hemo-dialysis (HD) with cardiac disease, 15 Renal Transplanted (RTx) patients in addition to 10 HD patients with no current or previous cardiac disease as a control group.
All patients in the study were subjected to echocardiog-raphy and assessment of fluid status by measuring of Inferior Vena Cava diameter (IVCd) by ultrasonography.
Results: Serum NT pro BNP levels in all included patients were elevated more than 10 folds the upper limit of normal with HD cardiac and RTx patients had 4 folds and 2 folds higher levels than the controls "HD non cardiac patients" respectively. We noticed a higher estimated Left Ventricular Ejection Fraction (LVEF) in RTx compared to HD patients and cut off values of >4.500pg/ml and 3.852pg/ml of the hormone for differentiating cardiac disease in HD and RTx patients respectively. We also found a significant diagnostic value of the hormone in the HD cardiac patients in differen-tiating cases with Systolic Dysfunction (SD) with cut off value of >5.500pg/ml, Left Ventricular Hypertrophy (LVH) and Coronary Artery Disease (CAD) with cut off value of 4.000-4.500pg/ml with all a high sensitivity of 87-100% and a relatively low specificity of 50%. NT pro BNP cut off value of >4.500pg/ml was helpful for detection of LVH in RTx patients while no value for detection of hydration status, differentiating cases with Diastolic Dysfunction (DD) in HD and Rtx patients or SD and CAD in Rtx patients.