Creation of dialysis vascular access with normal flow increases brain natriuretic peptide levels
Language English Country Netherlands Media print-electronic
Document type Comparative Study, Journal Article, Research Support, Non-U.S. Gov't
- MeSH
- Analysis of Variance MeSH
- Arteriovenous Shunt, Surgical * MeSH
- Biomarkers blood MeSH
- Time Factors MeSH
- Kidney Failure, Chronic blood therapy MeSH
- Renal Dialysis adverse effects methods MeSH
- Ventricular Dysfunction, Left blood etiology physiopathology MeSH
- Risk Assessment MeSH
- Cohort Studies MeSH
- Middle Aged MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Natriuretic Peptide, Brain analysis blood MeSH
- Normal Distribution MeSH
- Disease Progression MeSH
- Regression Analysis MeSH
- Renal Circulation physiology MeSH
- Aged MeSH
- Sensitivity and Specificity MeSH
- Heart Failure blood etiology physiopathology MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Comparative Study MeSH
- Names of Substances
- Biomarkers MeSH
- Natriuretic Peptide, Brain MeSH
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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