Do Natriuretic Peptide Measurements Provide Insights into Management of End-Stage Renal Disease Patients Undergoing Dial
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BIOMARKERS OF HEART FAILURE (WHW TANG AND J GRODIN, SECTION EDITOR)
Do Natriuretic Peptide Measurements Provide Insights into Management of End-Stage Renal Disease Patients Undergoing Dialysis? Thanat Chaikijurajai 1,2 & Hernan Rincon Choles 3 & W. H. Wilson Tang 1 Accepted: 8 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Impaired renal function may affect natriuretic peptide levels through a variety of factors and mechanisms, such as high prevalence of concomitant vascular and myocardial diseases, reduced clearance, increased risk of volume overload, and different types and solute removal techniques in the setting of dialysis. Nevertheless, accumulating evidence suggests that natriuretic peptide testing may provide insights into management of patients with chronic kidney disease (CKD) and end-stage kidney disease (ESRD) on dialysis, as they have been shown to be independently associated with morbidity and mortality. Recent Findings Rising natriuretic peptide levels over time may identify CKD patients more likely to approach ESRD and requiring dialysis initiation. Moreover, serial natriuretic peptide measurements may also be helpful in guiding fluid management in ESRD patients on dialysis. However, since patients with CKD usually have significantly higher and more variable baseline levels of natriuretic peptides than those without CKD, traditional cut-off values may not be applicable, and individualized trajectories should be applied and interpreted in the clinical context. Summary Routine clinical use natriuretic peptide testing in the CKD and ESRD settings still needs to be refined and individualized, yet their diagnostic and prognostic values can provide valuable insights into clinical trajectories and potential treatment responses. Keywords End-stage renal disease . Natriuretic peptide . Chronic kidney disease . Prognosis
Introduction Cardiovascular disease (CVD) is the most common comorbidity and the leading cause of death in patients with chronic kidney disease (CKD), especially end-stage renal disease (ESRD) [1]. According to the latest data from the United States Renal Data System [2], the prevalence of overall CVD in ESRD patients undergoing dialysis was found to be more This article is part of Topical Collection on Biomarkers of Heart Failure * W. H. Wilson Tang [email protected] 1
Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195, USA
2
Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
3
Department of Nephrology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
than 70%, with coronary artery disease and heart failure (HF) as leading causes, which accounted for 42.3 and 40.4% of dialysis patients, respectively. In terms of survival, ESRD patients who developed HF showed the greatest reduction in 2-year survival compared with other forms of
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