Gregg L Parker, Van Buren Peter N, Ramsey David J, Maydon Amaris, Banerjee Subhash, Walther Carl P, Virani Salim S, Winkelmayer Wolfgang C, Navaneethan Sankar D, Hedayati S Susan
Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
Medical Care Line, Section of Nephrology, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
J Investig Med. 2022 Jul 19. doi: 10.1136/jim-2022-002467.
Natriuretic peptide levels are elevated in persons with chronic kidney disease (CKD) stages 1-3, but it remains unclear whether this is associated with extracellular volume excess or early cardiovascular changes. We hypothesized that patients with CKD stages 1-3 would have evidence of cardiovascular changes, which would associate with brain natriuretic peptide (BNP), amino-terminal-pro-BNP (NT-pro-BNP), and patient-reported symptoms.Outpatients with CKD stages 1-3 and non-CKD controls were enrolled. Cardiovascular parameters included extracellular water (ECW) normalized to body weight measured using whole-body multifrequency bioimpedance spectroscopy, and total peripheral resistance index (TPRI) and cardiac index measured by impedance cardiography. Dyspnea, fatigue, depression, and quality of life were quantified using questionnaires.Among 21 participants (13 with CKD), median (IQR) BNP was 47.0 (28.0-302.5) vs 19.0 (12.3-92.3) pg/mL, p=0.07, and NT-pro-BNP was 245.0 (52.0-976.8) vs 26.0 (14.5-225.8) pg/mL, p=0.08, in the CKD and control groups, respectively. Those with CKD had higher pulse pressure (79 (66-87) vs 64 (49-67) mm Hg, p=0.046) and TPRI (3721 (3283-4278) vs 2933 (2745-3198) dyn×s/cm/m, p=0.01) and lower cardiac index (2.28 (2.08-2.78) vs 3.08 (2.43-3.37) L/min/m, p=0.02). In the overall cohort, natriuretic peptides correlated with pulse pressure (BNP r=0.59; NT-pro-BNP r=0.58), cardiac index (BNP r=-0.76; NT-pro-BNP r=-0.62), and TPRI (BNP r=0.48), p<0.05 for each, but not with ECW/weight. TPRI and blood pressure correlated moderately with symptoms.Elevated natriuretic peptides may coincide with low cardiac index and elevated peripheral resistance in patients with CKD stages 1-3. The role of these biomarkers to detect subclinical cardiovascular changes needs to be further explored.
慢性肾脏病（CKD）1 - 3期患者的利钠肽水平升高，但目前尚不清楚这是否与细胞外液量过多或早期心血管变化有关。我们推测，CKD 1 - 3期患者会出现心血管变化的证据，这些变化将与脑利钠肽（BNP）、氨基末端前脑钠肽（NT - pro - BNP）以及患者报告的症状相关。
纳入了CKD 1 - 3期的门诊患者和非CKD对照组。心血管参数包括使用全身多频生物电阻抗光谱法测量的归一化至体重的细胞外液（ECW），以及通过阻抗心动图测量的总外周阻力指数（TPRI）和心脏指数。使用问卷对呼吸困难、疲劳、抑郁和生活质量进行量化。
在21名参与者（13名CKD患者）中，CKD组和对照组的BNP中位数（IQR）分别为47.0（28.0 - 302.5）与19.0（12.3 - 92.3）pg/mL，p = 0.07；NT - pro - BNP分别为245.0（52.0 - 976.8）与26.0（14.5 - 225.8）pg/mL，p = 0.08。CKD患者的脉压更高（79（66 - 87）与64（49 - 67）mmHg，p = 0.046），TPRI更高（3721（3283 - 4278）与2933（2745 - 3198）dyn×s/cm/m，p = 0.01），而心脏指数更低（2.28（2.08 - 2.78）与3.08（2.43 - 3.37）L/min/m，p = 0.02）。在整个队列中，利钠肽与脉压（BNP r = 0.59；NT - pro - BNP r = 0.58）、心脏指数（BNP r = - 0.76；NT - pro - BNP r = - 0.62）和TPRI（BNP r = 0.48）相关，每项p均<0.05，但与ECW/体重无关。TPRI和血压与症状中度相关。
CKD 1 - 3期患者利钠肽升高可能与低心脏指数和外周阻力升高同时出现。这些生物标志物在检测亚临床心血管变化中的作用需要进一步探索。
