Ohno Shoko, Yokoi Hideki, Shinkawa Kanna, Fukuma Shingo, Yanagita Motoko
Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, JPN.
Department of Nephrology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, JPN.
Cureus. 2025 Jun 16;17(6):e86126. doi: 10.7759/cureus.86126. eCollection 2025 Jun.
Background Peritoneal dialysis (PD) is an integral modality in renal replacement therapy. However, inadequate fluid volume control is a key reason for PD withdrawal. Brain natriuretic peptide (BNP) is effective for evaluating fluid volume in PD patients. This study investigates whether BNP improvement after PD initiation reflects enhanced fluid control and correlates with longer PD duration. Methods A single-center retrospective observational study analyzed 99 patients who started PD between November 2002 and March 2022. BNP levels at PD initiation (BNP), and 6 months later (BNP) were used to calculate the BNP /BNP ratio. Patients were divided into BNP-improved and unimproved groups. PD duration was analyzed using the Kaplan-Meier method, and withdrawal risk from PD monotherapy was analyzed using a multivariable-adjusted Cox proportional hazards and nonlinear analysis. Results Seventy-one patients met the inclusion criteria, with a median follow-up period of 38 months. Kaplan-Meier analysis showed that the BNP-improved group had significantly longer PD monotherapy (log-rank test, P=0.0258). The Cox model indicated that a higher BNP/BNP ratio increased withdrawal risk from PD monotherapy (P=0.038). In the Poisson regression models, improved BNP levels were associated with continued PD monotherapy. Conclusion Improvement in BNP levels after PD initiation correlates with extended PD monotherapy. Regular BNP monitoring as a fluid volume control marker may contribute to assessing stable PD periods and improving the quality of life of patients.
背景 腹膜透析（PD）是肾脏替代治疗的重要方式。然而，液体量控制不佳是PD治疗中断的关键原因。脑钠肽（BNP）在评估PD患者的液体量方面很有效。本研究调查PD开始后BNP水平的改善是否反映了液体控制的增强，以及是否与更长的PD治疗时间相关。方法 一项单中心回顾性观察研究分析了2002年11月至2022年3月期间开始进行PD治疗的99例患者。使用PD开始时的BNP水平（BNP₀）和6个月后的BNP水平（BNP₆）来计算BNP₆/BNP₀比值。患者被分为BNP改善组和未改善组。使用Kaplan-Meier方法分析PD治疗时间，并使用多变量调整的Cox比例风险模型和非线性分析来分析PD单一疗法的退出风险。结果 71例患者符合纳入标准，中位随访期为38个月。Kaplan-Meier分析表明，BNP改善组的PD单一疗法持续时间显著更长（对数秩检验，P = 0.0258）。Cox模型表明，较高的BNP₆/BNP₀比值会增加PD单一疗法的退出风险（P = 0.038）。在Poisson回归模型中，BNP水平的改善与持续进行PD单一疗法相关。结论 PD开始后BNP水平的改善与延长PD单一疗法持续时间相关。定期监测BNP作为液体量控制指标可能有助于评估稳定的PD治疗期并改善患者的生活质量。
