Association Between Brain Natriuretic Peptide and Intradialytic Hypotension in Hemodialysis Patients: A Retrospective Study

Q: What are the key findings of this study?

Lower brain natriuretic peptide levels were independently associated with the occurrence of intradialytic hypotension (OR 0.999, p=0.030), with an optimal predictive cut-off of 390.8 pg/mL.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: End-stage kidney disease on hemodialysis (n=123). Intervention: Brain natriuretic peptide (BNP) levels vs. Higher BNP levels. Primary outcome: Occurrence of intradialytic hypotension (IDH) (OR 0.999, 95% CI 0.997-1.000, p=0.030).

Q: What does this research mean for the field?

Lower brain natriuretic peptide (BNP) levels are independently associated with the occurrence of intradialytic hypotension in hemodialysis patients and can serve as a predictor for this complication. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Hui Lü; Shanshan Cheng; Xingzi Liu; Meiling Jin; Fang Sun; Qianmei Sun

doi:10.3390/jcm15187021

September 10, 2026Journal of Clinical MedicineOpen Access

Association Between Brain Natriuretic Peptide and Intradialytic Hypotension in Hemodialysis Patients: A Retrospective Study

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Key result

Lower BNP below ~391 pg/mL is linked to higher risk of intradialytic hypotension.

OR 0.999
95% CI 0.997-1.000
P=0.030
n=123

Figures

Why the study?

Intradialytic hypotension is a common hemodialysis complication associated with poor prognosis, prompting investigation of associated factors and the value of BNP in predicting it.

Does brain natriuretic peptide (BNP) level predict the occurrence of intradialytic hypotension in hemodialysis patients?

Key Points

To evaluate factors associated with intradialytic hypotension in maintenance hemodialysis patients and assess the predictive value of brain natriuretic peptide.
Analyzed clinical data from a retrospective single-center cohort of 123 hemodialysis patients across 1,476 dialysis sessions.
Identified risk factors for intradialytic hypotension using univariate and multivariate logistic regression and determined optimal cut-off thresholds via receiver operating characteristic curve analysis.
Intradialytic hypotension occurred in 30.9% of patients (38 of 123), who exhibited lower brain natriuretic peptide levels (224.4 vs. 464.7 pg/mL, p = 0.001) and lower pre-hemodialysis diastolic blood pressure (75.7 vs. 84.1 mmHg, p = 0.001) compared with non-affected patients.
Multivariate logistic regression demonstrated that lower brain natriuretic peptide levels (OR = 0.999, 95% CI = 0.997–1.000, p = 0.030), lower pre-hemodialysis diastolic blood pressure (OR = 0.928, 95% CI = 0.877–0.982, p = 0.009), and higher body mass index (OR = 1.133, 95% CI = 1.011–1.270, p = 0.032) were independent predictors of intradialytic hypotension.
Receiver operating characteristic analysis of brain natriuretic peptide yielded an area under the curve of 0.695 (95% CI = 0.598–0.792, p = 0.001), with an optimal cut-off value of 390.8 pg/mL (sensitivity = 0.600, specificity = 0.842).

Study Design

Type

Cohort (n=123)

Multicenter

No

Structured PICO

Does brain natriuretic peptide (BNP) level predict the occurrence of intradialytic hypotension in hemodialysis patients?

P

Population

123 adult patients with end-stage kidney disease on maintenance hemodialysis with preserved ejection fraction, observed over 12 consecutive dialysis sessions.

E

Exposure

Brain natriuretic peptide (BNP) level measurement

O

Outcome

Occurrence of intradialytic hypotension (IDH) during 12 consecutive HD sessions following the measurement of BNP (defined as a decrease in systolic blood pressure by ≥20 mmHg or mean arterial pressure by ≥10 mmHg, with associated symptoms)composite

Main Result

Odds Ratio: 0.999 (95% CI 0.997–1)

p-value: p=0.030

Limitations

Retrospective observational cohort study with a relatively small number of patients and short duration
Single-center data without a validation cohort
Did not examine dietary sodium intake, dialysate sodium concentration, or sodium fluctuation
Did not have bioimpedance spectroscopy data to assess fluid status
retrospective observational cohort study with a relatively small number of patients and short duration
single-center data without a validation cohort
did not examine dietary sodium intake, dialysate sodium concentration, or sodium fluctuation
did not have bioimpedance spectroscopy data to assess fluid status

Implication

In hemodialysis patients with preserved ejection fraction, lower BNP levels are independently associated with an increased risk of intradialytic hypotension, suggesting its potential utility as a biomarker for volume depletion.

Abstract

Background: Intradialytic hypotension (IDH) is a common complication of hemodialysis (HD) and is associated with an increased risk of poor prognosis. This study investigated the factors associated with IDH in HD patients and explored the value of brain natriuretic peptide (BNP) in predicting IDH. Methods: Participants were divided into two groups according to the occurrence of IDH. Differences in clinical data between the IDH and no-IDH groups were analyzed, and the influencing factors of IDH were analyzed using logistic regression. A receiver operating characteristic (ROC) curve was applied to identify the optimal critical value of BNP for the occurrence of IDH in HD patients. Results: A total of 123 HD patients were included, in which the percentage of IDH was 30.9%. In patients with IDH, the levels of BNP (224.4 vs. 464.7 pg/mL, p = 0.001), pre-HD systolic blood pressure (SBP) (153.0 vs. 162.0 mmHg, p = 0.002), pre-HD diastolic blood pressure (DBP) (75.7 vs. 84.1 mmHg, p = 0.001), post-HD SBP (134.2 vs. 154.2 mmHg, p < 0.001) and DBP (72.8 vs. 84.0 mmHg, p < 0.001) were significantly lower than those in the non-IDH group, and the level of ejection fraction (66.5 vs. 64.1%, p = 0.039) was significantly higher. Univariate analysis showed that BNP [odds ratio (OR) = 0.999, p = 0.015], pre-HD SBP (OR = 0.960, p = 0.001), and DBP (OR = 0.944, p = 0.001) were associated with IDH. Multivariate analysis revealed that lower BNP levels (OR = 0.999, p = 0.030), lower pre-HD DBP levels (OR = 0.928, p = 0.009), and higher body mass index (BMI) (OR = 1.133, p = 0.032) were independently correlated with IDH. BNP had a predictive value for the occurrence of IDH. Conclusions: BNP showed predictive value for IDH and may serve as a useful predictor of this complication. Its independent association with IDH supported its potential utility in clinical decision-making.

Discussion

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Cite This Study

Lü et al. (2026) conducted a cohort in End-stage kidney disease on hemodialysis (n=123). Brain natriuretic peptide (BNP) levels vs. Higher BNP levels was evaluated on Occurrence of intradialytic hypotension (IDH) (OR 0.999, 95% CI 0.997-1.000, p=0.030). Lower brain natriuretic peptide levels were independently associated with the occurrence of intradialytic hypotension (OR 0.999, p=0.030), with an optimal predictive cut-off of 390.8 pg/mL.

synapsesocial.com/papers/6aa51ee4327956e4761f8d64 https://doi.org/10.3390/jcm15187021

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Association Between Brain Natriuretic Peptide and Intradialytic Hypotension in Hemodialysis Patients: A Retrospective Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association Between Brain Natriuretic Peptide and Intradialytic Hypotension in Hemodialysis Patients: A Retrospective Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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