Relationship between Natriuretic Peptides and Residual Diuresis during Continuous Hemodiafiltration

Abstract

Background: The reasons for the decrease or increase of urine output following the start of continuous venovenous hemodiafiltration (CVVHDF) have not yet been explained sufficiently. The renoprotective properties of natriuretic peptides were described. Methods: The levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were measured in 23 mechanically ventilated patients before and during the first 48 h of CVVHDF. Samples were drawn both from the ports proximal and distal to the filter. The results were compared between the group where daily diuresis (Vu) remained low or decreased and the group where diuresis increased to the level of 1.5 ml·kg^–1·h^–1 or higher after 48 h of treatment. Left ventricular dysfunction (LVD) was defined as LV ejection fraction below 40%. A control group consisted of 10 patients exposed to abdominal surgery. Results: The average AVdiff (%) of ANP and BNP on filter were insignificant. Patients with increasing diuresis (n = 12) had significantly lower levels of both ANP (p < 0.001) and BNP (p < 0.005) than the patients with decreasing diuresis (n = 11). Significant correlations were revealed for ANP and Vu (p < 0.01) and for BNP and Vu (p < 0.05). The levels of both peptides were grossly elevated in comparison to controls and were predictive of survival. The differences between cardiac and non-cardiac patients were significant both for ANP and for BNP. Conclusions: The elimination of ANP and BNP by the CVVHDF is negligible. The levels of natriuretic peptides are inversely related to Vu and predict survival. ANP and BNP levels correlate with left ventricular function even during acute renal failure and CVVHDF.

Journal

Journal ID (publisher-id): BPU

Journal ID (nlm-ta): Blood Purif

Journal ID (doi): 10.1159/issn.0253-5068

Title: Blood Purification

Publisher: S. Karger AG

ISSN (Print): 0253-5068

ISSN (Electronic): 1421-9735

Publication date Subscription-year: 2003

Publication date (Print): 2003

Publication date (Electronic): 03 November 2003

Volume: 21

Issue: 6

Pages: 401-408

Affiliations

^aDepartment of Anaesthesia and Intensive Care, University Hospital Královské Vinohrady, Prague, ^bDepartment of Clinical Biochemistry and Hematology, District Hospital, Kladno, ^cDepartment of Kinanthropology, Charles University, Prague, and ^d2nd Department of Medicine, University Hospital Královské Vinohrady, Prague, CzechRepublic

Article

Publisher ID: 73443 Other ID: Blood Purif 2003;21:401–408

DOI: 10.1159/000073443

PubMed ID: 14586183

Copyright statement: © 2003 S. Karger AG, Basel

License:

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Page count

Figures: 4, Tables: 1, References: 26, Pages: 8

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Categories

Subject: Original Paper