What kind of cardiac dysfunction do plasma natriuretic peptides represent in patients undergoing chronic hemodialysis

Left ventricular hypertrophy (LVH) is an extremely common condition in chronic hemodialysis (HD) patients. The clinical importance of LVH resides in the fact that LVH with systolic dysfunction is a predictor of cardiac death in HD patients independent of blood pressure. We studied whether atrial and brain natriuretic peptides (ANP, BNP) in HD patients represent cardiac dysfunction. For that purpose, we compared the relationship between plasma concentrations of ANP, BNP after the removal of fluid by ultrafiltration and echocardiographic data, H/M estimated by MIBG scintigrahy in 36 HD patients. The following results were obtained. Both plasma ANP and BNP levels were elevated in these patients. There was a positive correlation between plasma ANP and BNP levels. Plasma ANP concentrations correlated with left ventricular mass index (LVMI), but correlated inversely with H/M. However, plasma BNP levels correlated with A/E and LVMI, but inversely with left ventricular ejection fraction (LVEF) and H/M. Plasma BNP levels showed stronger correlation with these parameters than ANP. BNP/ANP after HD showed correlations with LVEF, A/E, LVMI and A/E. BNP/ANP showed stronger correlation with LVEF and A/E than BNP. HD patients with BNP/ANP above had severe left ventricular hypertrophy and systolic dysfunction. From these results, we conclude that elevated plasma BNP levels are a more sensitive marker of left ventricular dysfunction in HD patients than plasma ANP. In addition, HD patients with BNP/ANP above showed severe left ventricular hypertrophy with systolic dysfunction and impaired cardiac sympathetic nerve function.