TY - JOUR
T1 - Plasma BNP in patients on maintenance haemodialysis
T2 - A guide to management?
AU - Dastoor, Hormaz
AU - Bernieh, Bassam
AU - Boobes, Yousef
AU - Abouchacra, Samra
AU - Eltayeb, Elhadi
AU - Elhuda, Mustafa Nur
AU - Kazzam, Elsadig
AU - Obineche, Enyioma N.
AU - Nicholls, M. Gary
PY - 2005/1
Y1 - 2005/1
N2 - The number of patients requiring long-term haemodialysis is increasing throughout the world. Cardiovascular disease is much more common in these patients than in the general population and accounts for the majority of deaths. New approaches to management are clearly needed to reduce this excessive cardiovascular burden. We propose that circulating levels of the cardiac natriuretic peptides, B-type natriuretic peptide (BNP) in particular, might provide a useful, objective guide to the management of their hydration status and pharmacotherapy. An overview of the literature shows that plasma levels of the cardiac natriuretic peptides are increased in this patient population and reflect cardiac preload and after load along with cardiac pathology, thereby providing an index of cardiovascular (especially cardiac) stress and distress. Circulating levels of the cardiac peptides change in parallel with cardiac load, especially across haemodialysis. Furthermore, there is robust evidence that natriuretic peptide levels are predictive of cardiovascular outcome in these patients. Accordingly, we hypothesize that management of their haemodialysis, and pharmacotherapy designed specifically to lower plasma BNP levels to, or close to, the normal range, will reduce the excessive burden on the cardiovascular system and thereby ultimately lower the incidence of cardiovascular disease. We outline, in broad terms, how a trial to test this hypothesis might be designed.
AB - The number of patients requiring long-term haemodialysis is increasing throughout the world. Cardiovascular disease is much more common in these patients than in the general population and accounts for the majority of deaths. New approaches to management are clearly needed to reduce this excessive cardiovascular burden. We propose that circulating levels of the cardiac natriuretic peptides, B-type natriuretic peptide (BNP) in particular, might provide a useful, objective guide to the management of their hydration status and pharmacotherapy. An overview of the literature shows that plasma levels of the cardiac natriuretic peptides are increased in this patient population and reflect cardiac preload and after load along with cardiac pathology, thereby providing an index of cardiovascular (especially cardiac) stress and distress. Circulating levels of the cardiac peptides change in parallel with cardiac load, especially across haemodialysis. Furthermore, there is robust evidence that natriuretic peptide levels are predictive of cardiovascular outcome in these patients. Accordingly, we hypothesize that management of their haemodialysis, and pharmacotherapy designed specifically to lower plasma BNP levels to, or close to, the normal range, will reduce the excessive burden on the cardiovascular system and thereby ultimately lower the incidence of cardiovascular disease. We outline, in broad terms, how a trial to test this hypothesis might be designed.
KW - Brain natriuretic peptide
KW - Cardiac natriuretic peptides
KW - Chronic renal failure
KW - Haemodialysis
KW - Hypertension
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U2 - 10.1097/00004872-200501000-00006
DO - 10.1097/00004872-200501000-00006
M3 - Review article
C2 - 15643118
AN - SCOPUS:12344251805
SN - 0263-6352
VL - 23
SP - 23
EP - 28
JO - Journal of Hypertension
JF - Journal of Hypertension
IS - 1
ER -