Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA.
Nephrol Dial Transplant. 2013 Dec;28(12):3082-9. doi: 10.1093/ndt/gft054. Epub 2013 Mar 22.
Although the cardiac biomarker B-type natriuretic peptide (BNP) is strongly related to mortality in end-stage renal disease (ESRD), whether it is a predictor of weight change or blood pressure (BP) response upon probing dry weight among hypertensive hemodialysis patients remains unknown. The purpose of this study was to examine among people with hypertension on hemodialysis whether BNP is a biomarker of excess volume.
Hypertensive hemodialysis patients (n = 150) were randomized to a control group (n = 50) or an ultrafiltration group (n = 100) and followed up for 30 dialysis treatments. After a baseline run-in of six treatments, those assigned to the ultrafiltration group had dry weight probed over 8 weeks. Forty-four-hour interdialytic ambulatory BP and predialysis BNP were measured at the end of run-in period, at 4 weeks and at 8 weeks.
The median BNP concentration was 93 pg/mL (interquartile range 31-257 pg/mL). The magnitude of decline in the BNP depended on the baseline concentration of BNP, but did not require probing dry weight or weight loss. No relationship existed between decline in postdialysis weight upon probing dry weight and baseline BNP. Furthermore, reduction in the BNP was not required for decline in postdialysis weight. Predialysis log BNP modestly predicted ambulatory systolic and pulse pressure independently of other risk factors. No relationship was found between decline in BP upon probing dry weight and baseline BNP. Upon probing dry weight, reduction in BNP was not required for decline in systolic ambulatory BP.
Taken together, these data suggest that among hypertensive patients on hemodialysis BNP is not a volume marker.
尽管心脏生物标志物 B 型利钠肽（BNP）与终末期肾病（ESRD）患者的死亡率密切相关，但在高血压血液透析患者中，BNP 是否是预测干体重时体重变化或血压（BP）反应的指标尚不清楚。本研究的目的是检查高血压血液透析患者中，BNP 是否是容量过多的生物标志物。
将 150 例高血压血液透析患者随机分为对照组（n = 50）或超滤组（n = 100），并随访 30 次透析治疗。在基线 6 次治疗的预适应期后，将超滤组的患者在 8 周内进行干体重探测。在预适应期末、4 周和 8 周时，测量 44 小时的日间动态血压和透析前 BNP。
BNP 浓度中位数为 93pg/mL（四分位距 31-257pg/mL）。BNP 下降幅度取决于 BNP 的基线浓度，但不需要探测干体重或体重减轻。在探测干体重时，后透析体重的下降与 BNP 无相关性。此外，后透析体重的下降不需要 BNP 下降。透析前 log BNP 与其他危险因素独立预测日间收缩压和脉压。在探测干体重时，BP 的下降与 BNP 无相关性。在探测干体重时，BNP 的下降不需要降低日间收缩压。
综上所述，这些数据表明，在高血压血液透析患者中，BNP 不是容量标志物。
