Key result
Single hemodialysis session is linked to ~54% lower copeptin levels in cardiac-healthy patients.
Why the study?
The influence of haemodialysis on modern peptide biomarkers and echocardiographic parameters in cardiac healthy patients with end stage renal disease was not well characterized.
Does haemodialysis alter modern peptide biomarkers and echocardiographic parameters in cardiac healthy patients with end-stage renal disease?
Observational (n=20)
No
Does haemodialysis alter modern peptide biomarkers and echocardiographic parameters in cardiac healthy patients with end-stage renal disease?
Absolute Event Rate: 63% vs 159%
p-value: p=<0.001
In cardiac healthy hemodialysis patients, modern peptide biomarkers are significantly altered by the dialysis process and fluid shifts, necessitating individualized interpretation combined with clinical and echocardiographic data.
Acute HD reductions in copeptin/MR-proANP should not change practice; leaves open their prognostic utility in ESRD.
BACKGROUND: In this prospective study, we aimed to assess the haemodynamic changes before and after haemodialysis (HD) in cardiac healthy subjects on chronic HD by imaging methods and endocrine markers of fluid balance. METHODS: Mid-regional pro-atrial natriuretic peptide (MR-proANP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), vasopressin (AVP) and copeptin (CT-proAVP), metanephrines and normetanephrines, renin and aldosterone, standard transthoracic echocardiography and diameter of vena cava inferior (VCID) were performed in 20 patients with end stage renal disease (CKD5D) before and after HD and were stratified in residual excretion (RE, less or more 0.5 l) and ultrafiltration rate (UF, less or more 2 l). RESULTS: Copeptin was significantly higher in patients before HD. Copeptin was inversely correlated with haemodialysis treatment adequacy (KT/v), RE and UF, but was not significantly influenced by age, gender and body mass index (BMI). MR-proANP was significantly reduced by haemodialysis by 27% and was inversely correlated with KT/v, but there was a significant influence by UF, RE, age, gender and BMI. NT-proBNP was significantly higher in patients before HD and was not influenced by RE and UF. Renin, aldosterone, metanephrines and normetanephrines did not demonstrate significant differences. Echocardiographic parameters and VCID were significantly correlated with RE, UF and copeptin. CONCLUSION: Modern biomarkers will provide cardiovascular risk assessment, but elimination (UF), RE and other factors may influence the serum concentrations, e.g. in patients with renal impairment. The interpretation will be limited by altered reference ranges, and will be restricted to individual courses combined with clinical and echocardiographic data.
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Rasche et al. (2017) conducted an observational in End-stage renal disease (CKD5D) on chronic haemodialysis (n=20). Haemodialysis vs. Pre-haemodialysis (baseline) was evaluated on Copeptin (CT-proAVP) concentration (p=<0.001). In cardiac healthy hemodialysis patients, a single hemodialysis session significantly reduced elevated baseline copeptin levels by 54% and MR-proANP levels by 27%.
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