What question did this study set out to answer?

To evaluate the response of atrial natriuretic peptide and plasma renin activity to fluctuations in fluid status among hemodialysis patients with and without heart failure.

March 1, 1991Journal of Internal Medicine

Atrial natriuretic peptide in dialysis patients under various conditions of volume homeostasis

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Why the study?

Does alteration of volume status during haemodialysis affect atrial natriuretic peptide levels in ESRD patients with and without heart failure?

Population

19 patients with end-stage renal disease under haemodialysis, divided into three groups: group A, group B…

Comparison

Haemodialysis with ultrafiltration and a volume… vs Isovolaemic haemodialysis and comparison between…

Design

Cohort

Follow-up

During haemodialysis session

Authors

JPJ. PlümKlinikum Kassel BGB. GrabenseeHeinrich Heine University Düsseldorf

Discussion

Member takes

Implication

ANP tracks acute volume shifts during HD, most markedly in HF; hypothesis-generating and requires prospective validation before clinical use.

Key Points

To evaluate the response of atrial natriuretic peptide and plasma renin activity to fluctuations in fluid status among hemodialysis patients with and without heart failure.
Assessed 19 patients with end-stage renal disease undergoing hemodialysis across three cohorts: group A without heart failure undergoing ultrafiltration (n=6, mean age 41 ± 15 years), group B without heart failure on isovolemic hemodialysis (n=6, mean age 54 ± 15 years), and group C with heart failure undergoing ultrafiltration (n=7, mean age 60 ± 3 years).
Measured atrial natriuretic peptide (ANP), plasma renin activity (PRA), blood pressure, and heart rate before dialysis, during ultrafiltration or isovolemic dialysis, and following an end-dialysis volume bolus.
Predialysis ANP levels were significantly higher than normal reference values (62 ± 27 pg ml⁻¹), reaching 1534 ± 471 pg ml⁻¹ in group C, 476 ± 168 pg ml⁻¹ in group A, and 236 ± 138 pg ml⁻¹ in group B.
Ultrafiltration-induced weight reduction strongly correlated with declines in ANP in group A (r = 0.88) and group C (r = 0.98), whereas isovolemic dialysis produced no changes in ANP levels.
A post-dialysis volume bolus caused an immediate rise in ANP across all cohorts that was most prominent in heart failure patients, while blood pressure, heart rate, and plasma renin activity did not correlate with ANP.

Structured PICO

Does alteration of volume status during haemodialysis affect atrial natriuretic peptide levels in ESRD patients with and without heart failure?

Population

19 patients with end-stage renal disease (ESRD) under haemodialysis (HD), divided into three groups: group A (n=6, mean age 41, no heart failure, needing ultrafiltration), group B (n=6, mean age 54, no heart failure, isovolaemic HD), and group C (n=7, mean age 60, heart failure NYHA III-IV, needing ultrafiltration).

Intervention

Haemodialysis with ultrafiltration and a volume bolus at the end of HD

Comparator

Isovolaemic haemodialysis (group B) and comparison between patients with and without heart failure

Outcome

Atrial natriuretic peptide (ANP) levelssurrogate

ANP levels are highly sensitive to changes in body fluid status during haemodialysis in ESRD patients, with the most pronounced responses seen in those with concomitant heart failure.

Cite This Study

Plüm et al. (1991) studied this question.

synapsesocial.com/papers/6a9909941c4dac29babd4e8b https://doi.org/10.1111/j.1365-2796.1991.tb00334.x

Topics

Heart failure HFrEF treatment

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Implication

ANP tracks acute volume shifts during HD, most markedly in HF; hypothesis-generating and requires prospective validation before clinical use.

Atrial natriuretic peptide in dialysis patients under various conditions of volume homeostasis

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Atrial natriuretic peptide in dialysis patients under various conditions of volume homeostasis

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider