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.
Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Curr Heart Fail Rep. 2020 Dec;17(6):449-456. doi: 10.1007/s11897-020-00488-6. Epub 2020 Sep 17.
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.
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. 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.
肾功能受损可能通过多种因素和机制影响利钠肽水平，例如同时存在的血管和心肌疾病高发、清除率降低、容量超负荷风险增加，以及透析时不同类型和溶质清除技术。然而，越来越多的证据表明，利钠肽检测可能为慢性肾脏病（CKD）和透析终末期肾病（ESRD）患者的管理提供思路，因为它们与发病率和死亡率独立相关。
利钠肽水平随时间升高可能会识别出更有可能进展为 ESRD 并需要开始透析的 CKD 患者。此外，连续的利钠肽测量也可能有助于指导透析中 ESRD 患者的液体管理。然而，由于 CKD 患者的利钠肽基线水平通常比无 CKD 患者高得多且变化更大，因此传统的截断值可能不适用，应在临床背景下应用和解释个体化轨迹。在 CKD 和 ESRD 环境中常规进行临床应用利钠肽检测仍需要进一步完善和个体化，但其诊断和预后价值可以为临床轨迹和潜在治疗反应提供有价值的见解。
