Predictive values of ANP, BNP and cyclic-GMP for determining appropriate volume state in patients on chronic dialysis

We studied whether ANP, BNP and c-GMP are valuable for estimating the appropriate volume state (dry weight) in patients on chronic dialysis. In patients undergoing hemodialysis (HD), 1) Pre-dialysis ANP, BNP and c-GMP were markedly elevated as compared to those of normal subjects. The pre-HD levels of ANP, BNP, and c-GMP decreased after a single HD session. The post-ANP, BNP and c-GMP in patients with DM were significantly higher in non-DM patients. 2) A positive correlation was recognized between pre-ANP and pre-BNP, pre-BNP and pre-c-GMP, and pre-ANP and pre-c-GMP. A similar relationship was identified among three parameters on the post-HD measurements. These correlations were unclear in the presence of DM. 3) A positive correlation was recognized between Δc-GMP and fluid removal (%ΔBW), but not between ΔANP and %ΔBW, or between ΔBNP and %ΔBW. In patients undergoing CAPD, 4) ANP, BNP, and c-GMP levels were markedly elevated as compared to those in normal subjects, and were similar to the post-HD values. 5) A significant positive correlation was identified between ANP and BNP, BNP and c-GMP, and c-GMP and ANP. 6) Unlike HD patients, no relationship was found between c-GMP and blood pressure. The present results suggest that among the three parameters, c-GMP and ANP are of predictive value for determining the appropriate body fluid state in both HD and CAPD patients. Thus, c-GMP is possibly the best indicator for determining the DW of patients. In the presence of DM, the significance of these parameters may be problematic.