Key result
Unimproved brain natriuretic peptide levels six months after peritoneal dialysis initiation were associated with a increased risk of withdrawal from PD monotherapy.
Why the study?
Inadequate fluid volume control is a key reason for peritoneal dialysis withdrawal, and it is unknown whether BNP improvement after initiation reflects enhanced fluid control and correlates with longer duration.
Does improvement in BNP levels after peritoneal dialysis initiation correlate with extended PD monotherapy duration in adult patients with end-stage kidney disease?
Observational (n=71)
No
Does improvement in BNP levels after peritoneal dialysis initiation correlate with extended PD monotherapy duration in adult patients with end-stage kidney disease?
Improvement in BNP levels 6 months after initiation of peritoneal dialysis is associated with a significantly longer duration of PD monotherapy, suggesting BNP is a useful marker for fluid volume control.
Answers are grounded in this paper and cite their sources.
BNP trends may inform PD fluid management decisions; leaves open whether BNP-targeted strategies extend monotherapy duration.
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 (BNP0M), and 6 months later (BNP6M) were used to calculate the BNP6M /BNP0M 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 BNP6M/BNP0M 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.
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Ohno et al. (2025) conducted an observational in End-stage renal disease (n=71). Unimproved BNP levels (BNP6M/BNP0M > 1) vs. Improved BNP levels (BNP6M/BNP0M < 1) was evaluated on Withdrawal from PD monotherapy (composite of mortality, transition to HD, and transition to hybrid therapy) (HR 2.25, 95% CI 1.17-4.34, p=0.038). Unimproved brain natriuretic peptide levels six months after peritoneal dialysis initiation were associated with a increased risk of withdrawal from PD monotherapy.
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