Key result
Hemodialysis using a super-flux dialyzer significantly reduced plasma levels of all measured BNP-related peptides, including total BNP by 38.9% and proBNP by 29.7%, in a nearly molecular weight-dependent manner.
Why the study?
Does hemodialysis using super-flux dialyzers reduce plasma levels of BNP-related peptides in ESRD patients?
Observational (n=141)
No
Does hemodialysis using super-flux dialyzers reduce plasma levels of BNP-related peptides in ESRD patients?
Answers are grounded in this paper and cite their sources.
Hemodialysis using super-flux dialyzers significantly removes BNP-related peptides in a molecular weight-dependent manner, which may affect the interpretation of these biomarkers in ESRD patients.
BACKGROUND: Plasma BNP levels are predictive of prognosis in hemodialysis patients. However, recent studies showed that the current BNP immunoassay cross-reacts with glycosylated proBNP, and the NT-proBNP assay underestimates glycosylated NT-proBNP. In addition, the recently developed high performance dialyzer removes medium-sized molecular solutes such as β2-microgloburin. We therefore investigated the effects of high performance dialysis on measured levels of glycosylated proBNP, glycosylated NT-proBNP and other BNP-related peptides in end-stage renal disease (ESRD) patients on hemodialysis. METHOD: The relationships between clinical parameters and BNP-related molecule were also investigated. We used our newly developed immunoassay to measure plasma total BNP and proBNP in 105 normal subjects and 36 ESRD patients before and after hemodialysis. Plasma NT-proBNP was measured using Elecsys II after treatment with or without deglycosylating enzymes. We also measured plasma ANP and cGMP using radioimmunoassays. RESULTS: All the measured BNP-related peptides were significantly higher in ESRD patients than healthy subjects. Total BNP (-38.9%), proBNP (-29.7%), glycoNT-proBNP (-45.5%), nonglycoNT-proBNP (-53.4%), ANP (-50.4%) and cGMP (-72.1%) were all significantly reduced after hemodialysis, and the magnitude of the reduction appeared molecular weight- dependent. Both the proBNP/total BNP and glycoNT-proBNP/nonglycoNT-proBNP ratios were increased after hemodialysis. The former correlated positively with hemodialysis vintage and negatively with systolic blood pressure, while the latter correlated positively with parathyroid hormone levels. CONCLUSION: These results suggest that hemodialysis using super-flux dialyzer removes BNP-related peptides in a nearly molecular weight-dependent manner. The ProBNP/total BNP and glycoNT-proBNP/nonglycoNT-proBNP ratios appear to be influenced by hemodialysis-related parameters in ESRD patients on hemodialysis.
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Nakagawa et al. (2014) conducted an observational in End-Stage Renal Disease (ESRD) (n=141). Hemodialysis using super-flux dialyzer vs. Before hemodialysis (baseline) was evaluated on Change in plasma levels of BNP-related peptides (total BNP, proBNP, glycoNT-proBNP, nonglycoNT-proBNP, ANP, cGMP) after hemodialysis (p=<0.001). Hemodialysis using a super-flux dialyzer significantly reduced plasma levels of all measured BNP-related peptides, including total BNP by 38.9% and proBNP by 29.7%, in a nearly molecular weight-dependent manner.
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