Odar-Cederlöf Ingegerd, Bjellerup Per, Williams Amy, Blagg Christopher R, Twardowski Zbylut, Ting George, Kjellstrand Carl M
Division of Nephrology, Karolinska University Hospital, Stockholm, Sweden.
Hemodial Int. 2006 Oct;10(4):394-8. doi: 10.1111/j.1542-4758.2006.00136.x.
Brain natriuretic peptide or B-type natriuretic peptide (BNP) is a sensitive marker of heart disease. Plasma levels of BNP increase in left ventricular failure and determination of plasma BNP has become a useful tool in the diagnosis of heart failure. Hemodialysis (HD) patients may have elevated plasma levels of BNP, particularly predialysis, that correlate with echocardiographic signs of left ventricular dysfunction. High BNP levels are also a strong predictor of mortality in both nonrenal and HD patients. We studied plasma BNP levels in patients who changed from conventional thrice-weekly dialysis to daily dialysis 6 times a week while maintaining a total weekly time on dialysis of 12 hr. Twelve HD patients, mean age 55 years, had 4 hr of conventional thrice-weekly treatment for 4 weeks. Predialysis and postdialysis blood samples were obtained at the last dialysis. Patients were then dialyzed for 2 hr, 6 times weekly, for 4 weeks (daily dialysis). Again, predialysis and postdialysis blood samples were collected at the last HD. Brain natriuretic peptide plasma concentrations were determined by immunoradiometric assay. Predialysis BNP levels decreased from 194+/-51 ng/L (68+/-19 pmol/L; mean+SE) during thrice-weekly HD to 113+/-45 ng/L (41+/-18 pmol/L; p = 0.001) after 4 weeks on daily dialysis. With thrice-weekly HD, predialysis BNP levels were higher than postdialysis levels: 120+/-26 ng/L (39+/-8 pmol/L; p = 0.059). With daily dialysis, predialysis BNP levels did not differ significantly from postdialysis levels. Elevated predialysis plasma levels of BNP, considered sensitive and early markers of left ventricular dysfunction, decreased when patients were changed from conventional thrice-weekly HD to daily dialysis maintaining total hours of dialysis per week constant. Given the accumulated evidence that BNP is a biomarker of left ventricular dysfunction and can be used for risk stratification and guidance in pharmacotherapy of heart failure, daily dialysis appears to lead to less cardiac distress.
脑钠肽或B型钠尿肽（BNP）是心脏病的敏感标志物。左心室衰竭时血浆BNP水平会升高，测定血浆BNP已成为诊断心力衰竭的一项有用工具。血液透析（HD）患者，尤其是透析前，血浆BNP水平可能会升高，这与左心室功能障碍的超声心动图表现相关。高BNP水平也是非肾性患者和HD患者死亡的有力预测指标。我们研究了从传统的每周三次透析改为每周6次每日透析，同时保持每周总透析时间为12小时的患者的血浆BNP水平。12名HD患者，平均年龄55岁，接受4周每周三次、每次4小时的传统治疗。在最后一次透析时采集透析前和透析后的血样。然后患者每周进行6次、每次2小时的透析，共4周（每日透析）。同样，在最后一次HD时采集透析前和透析后的血样。通过免疫放射分析测定血浆脑钠肽浓度。透析前BNP水平从每周三次HD时的194±51 ng/L（68±19 pmol/L；平均值±标准误）降至每日透析4周后的113±45 ng/L（41±18 pmol/L；p = 0.001）。每周三次HD时，透析前BNP水平高于透析后水平：120±26 ng/L（39±8 pmol/L；p = 0.059）。每日透析时，透析前BNP水平与透析后水平无显著差异。当患者从传统的每周三次HD改为每日透析且每周总透析时间保持不变时，被视为左心室功能障碍敏感和早期标志物且升高的透析前血浆BNP水平降低。鉴于越来越多的证据表明BNP是左心室功能障碍的生物标志物，可用于心力衰竭的风险分层和药物治疗指导，每日透析似乎导致心脏不适减轻。
