The Impact of Volume Removal by Hemodialysis on Elevated NT-proBNP Levels in Patients With Hypervolemia
Year: 2025
Type: article
Study design: Observational Study
Abstract: INTRODUCTION AND AIM: N-terminal pro-brain-type natriuretic peptide (NT-proBNP) is highly sensitive and specific for the diagnosis of congestive heart failure (CHF). Most patients with end-stage kidney disease (ESKD) on renal replacement therapy have an elevated NT-proBNP plasma level due to volume gain between dialysis sessions. Measuring plasma NT-proBNP levels before and after hemodialysis (HD) in patients hospitalized with volume expansion is a common practice. This study aimed to determine the clinical value of repeated plasma NT-proBNP measurements in patients with ESKD or acute kidney injury (AKI) requiring HD and to study the effect of volume removal via HD on NT-proBNP plasma levels. METHODS: We conducted a retrospective analysis of patients admitted to two community hospitals over a three-year period (from January 1, 2020, to December 31, 2022). Patients with AKI requiring HD or ESKD were screened if they had an admission diagnosis of volume expansion including acute CHF or pulmonary edema that was verified radiographically and by physical examination. Patients who had a plasma NT-proBNP level measured at admission and a repeat measurement 2-12 hours after HD were included in this study. Over the three-year period, 36 patients with ESKD and five patients with AKI requiring HD fulfilled the inclusion criteria. RESULTS: Volume removal via HD had no impact on NT-proBNP levels in ESKD or AKI patients (ESKD p=0.7858 and AKI p=0.6903). Our patients exhibited markedly elevated NT-proBNP due to volume expansion and renal dysfunction. During the study period, 30% of the patients with ESKD (11/36) died. CONCLUSION: Volume expansion is the main factor causing elevated NT-proBNP levels in acute or chronic HD patients. Reducing predialysis volume expansion with a single hemodialysis session has no impact on NT-proBNP level. Therefore, repeating the NT-proBNP level post-HD has no clinical value. Our data suggest that NT-proBNP is a useful cardiac biomarker for volume expansion, and its elevated level predicts high cardiovascular mortality and recurrent hospitalizations in acute and chronic HD patients.
Source: Cureus
DOI: 10.7759/cureus.85554
Authors: Mohammad Tinawi, Bahar Bastani
Institution: Saint Louis University
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4411124813