NT-proBNP as a biomarker for fluid management in hemodialysis patients: Insights from CHF and Non-CHF subgroups

Mehmet Polat; Özgür Kılıç

NT-proBNP as a biomarker for fluid management in hemodialysis patients: Insights from CHF and Non-CHF subgroups

Abstract

The secrection of N-terminal probrain natriuretic peptide (NT-proBNP) is triggered by elevated myocardial strain and excess volume in the left ventricle (LV). The association between NT-proBNP and volume status in hemodialysis (HD) patients with congestive heart failure (CHF) is not fully understood. We aimed to elucidate this relationship. HD patients undergoing treatment for more than three months were included. Volume overload was defined using interdialytic weight gain (IDWG) between HD sessions. CHF was diagnosed with left ventricle ejection fraction ( LVEF) below 60%. The predictive capacity of NT-proBNP for volume overload in patients, both with and without CHF, was retrospectively analyzed. The cohort was composed of 144 HD patients, 85 males and 59 females, with a median age of 62 years (IQR: 52-74). The median level of NT-proBNP was 4936 pg/ml (IQR: 2430–21217 pg/ml). The average IDWG was 5.3±2.0%, with a median dialysis duration of 48 (IQR: 26.9–93.4) months. Elevated NT-proBNP levels were significantly associated with a higher risk of volume overload (OR = 1.9; 95% CI: 1.304–2.630 p=0.002), independent of age, gender, serum potassium, serum uric acid, and CHF status. The area under the curve (AUC) for predicting volume overload using NT-proBNP was 0.865 [95% CI: 0.791–0.940 p < 0.001] in patients without CHF and 0.832 [95% CI: 0.682–0.981 p = 0.001] in those with CHF. The NT-proBNP cutoff was 3512 pg/ml for patients without CHF and 4936 pg/ml for those with CHF. Increased NT-proBNP levels are linked to a higher risk of fluid overload in HD patients.regardless of CHF status, highlighting NT-proBNP as a valuable tool for managing fluid balance in this population.

Keywords

Ethical Statement

The study was conducted with the approval of the Institutional Review Board of Nevsehir Hacı Bektaş Veli University with approval number 2400087905/2024.05.01.Because of the study's retrospective design, informed consent was not required.

References

Siriopol D, Siriopol M, Stuard S, et al. An analysis of the impact of fluid overload and fluid depletion for all-cause and cardiovascular mortality. Nephrol Dial Transplant. 2019;34(8):1385-1393. doi:10.1093/ndt/gfy396
Dekker MJE, Kooman JP. Fluid status assessment in hemodialysis patients and the association with outcome: review of recent literature. Curr Opin Nephrol Hypertens. 2018;27(3):188-193. doi:10.1097/MNH.0000000000000409
Dekker MJ, Marcelli D, Canaud BJ, et al. Impact of fluid status and inflammation and their interaction on survival: a study in an international hemodialysis patient cohort. Kidney Int. 2017;91(5):1214-1223. doi:10.1016/j.kint.2016.12.008
Loutradis C, Sarafidis PA, Ferro CJ, Zoccali C. Volume overload in hemodialysis: diagnosis, cardiovascular consequences, and management. Nephrol Dial Transplant. 2021;36(12):2182-2193. doi:10.1093/ndt/gfaa182
Wang Y, Cao X, Yu J, et al. Association of N-Terminal Pro-brain Natriuretic Peptide With Volume Status and
Cardiac Function in Hemodialysis Patients. Front Cardiovasc Med. 2021;8:646402. Published 2021 Feb 22. doi:10.3389/fcvm.2021.646402
Chaikijurajai T, Choles HR, Tang WHW. Do Natriuretic Peptide Measurements Provide Insights into Management of End-Stage Renal Disease Patients Undergoing Dialysis? Curr Heart Fail Rep. 2020;17(6):449-456. doi:10.1007/s11897- 020-00488-6
Akkus G, Seyithanoglu M, Akkus H, Ulu S, Ciftcioglu M, Erken E, Altunoren O, Gungor O. Serum NT-proBNP levels are associated with cognitive functions in hemodialysis patients. Semin Dial. 2021 Mar;34(2):170-175. doi:10.1111/sdi.12948. Epub 2021 Jan 10. PMID: 33423325.

Fouque D, Vennegoor M, ter Wee P, et al. EBPG guideline on nutrition. Nephrol Dial Transplant. 2007;22 Suppl 2
Han BG, Lee JY, Kim JS, Yang JW, Park SW. The mediating role of the left ventricular mass index on the relationship between the fluid balance and left ventricular diastolic function in patients with chronic kidney disease. Kidney Res Clin Pract. 2024;43(1):101-110. doi:10.23876/j.krcp.22.246
Park WY, Park S, Kim YW, Jin K. Clinical efficacy of biomarkers for evaluation of volume status in dialysis patients. Medicine (Baltimore). 2020;99(31).
Alexandrou ME, Balafa O, Sarafidis P. Assessment of Hydration Status in Peritoneal Dialysis Patients: Validity, Prognostic Value, Strengths, and Limitations of Available Techniques. Am J Nephrol. 2020;51(8):589-612. doi:10.1159/000509115
Liu T, Zhao D, Huang J, et al. Research hotspots and development trends in volume management of peritoneal dialysis patients: a bibliometrics and visual analysis up to 2022. Int Urol Nephrol. Published online November 22, 2023. doi:10.1007/s11255-023-03869-7
Canaud B, Kooman J, Maierhofer A, Raimann J, Titze J, Kotanko P. Sodium First Approach to Reset Our Mind for Improving Management of Sodium, Water, Volume, and Pressure in Hemodialysis Patients and to Reduce Cardiovascular Burden and Improve Outcomes. Front Nephrol. 2022;2:935388. Published 2022 Jul 7. doi:10.3389/fneph.2022.935388
Zoair AM, Abdel-Hafez MA, Mawlana W, Sweylam MA. Serum levels of N-terminal-pro B-type natriuretic peptide as a diagnostic marker for left ventricular dysfunction in children with end-stage renal disease on hemodialysis. Saudi J Kidney Dis Transpl. 2016;27(6):1114-1122. doi:10.4103/1319-2442.
Ishigami J, Iimori S, Kuwahara M, Sasaki S, Tsukamoto Y. Diagnostic value of B-type natriuretic peptide for estimating left atrial size and its usefulness for predicting all-cause mortality and cardiovascular events among chronic haemodialysis patients. Nephrology (Carlton). 2014;19(12):777-783. doi:10.1111/nep.12329
Palmer SC, Yandle TG, Nicholls MG, Frampton CM, Richards AM. Regional clearance of amino-terminal pro-brain natriuretic peptide from human plasma. Eur J Heart Fail. 2009;11(9):832-839. doi:10.1093/eurjhf/hfp099
Potter JM, Simpson AJ, Kerrigan J, et al. The relationship of plasma creatinine (as eGFR) and high-sensitivity cardiac troponin and NT-proBNP concentrations in a hospital and community outpatient population. Clin Biochem. 2017;50(15):813-815. doi:10.1016/j.clinbiochem.2017.04.003
Bruch C, Fischer C, Sindermann J, Stypmann J, Breithardt G, Gradaus R. Comparison of the prognostic usefulness of N-terminal pro-brain natriuretic Peptide in patients with heart failure with versus without chronic kidney disease. Am J Cardiol. 2008;102(4):469-474. doi:10.1016/j.amjcard.2008.03.082
Masson S, Latini R. Amino-terminal pro-B-type natriuretic peptides and prognosis in chronic heart failure. Am J Cardiol. 2008;101(3A):56-60. doi:10.1016/j.amjcard.2007.11.024
Kristensen SL, Jhund PS, Køber L, et al. Relative Importance of History of Heart Failure Hospitalization and N- Terminal Pro-B-Type Natriuretic Peptide Level as Predictors of Outcomes in Patients With Heart Failure and Preserved Ejection Fraction. JACC Heart Fail. 2015;3(6):478-486. doi:10.1016/j.jchf.2015.01.014
Yin L, Han Z, Zhang Q, Xie J, Wang C, Zhao L. The effect of hemodialysis on N-terminal pro-brain natriuretic peptide: A systematic review and meta-analysis. Am J Emerg Med. 2021;44:244-249. doi:10.1016/j.ajem.2020.03.056
Olsen MH, Hansen TW, Christensen MK, et al. N-terminal pro brain natriuretic peptide is inversely related to metabolic cardiovascular risk factors and the metabolic syndrome. Hypertension. 2005;46(4):660-666. doi:10.1161/01.HYP.0000179575.13739.72
Wang TJ, Larson MG, Levy D, et al. Impact of obesity on plasma natriuretic peptide levels. Circulation. 2004;109(5):594-600. doi:10.1161/01.CIR.0000112582.16683.EA
Lainscak M, von Haehling S, Anker SD. Natriuretic peptides and other biomarkers in chronic heart failure: from BNP, NT-proBNP and MR-proANP to routine biochemical markers. Int J Cardiol. 2009;132(3):303-311. doi:10.1016/j.ijcard.2008.11.149
Arbab-Zadeh A, Dijk E, Prasad A, et al. Effect of aging and physical activity on left ventricular compliance. Circulation. 2004;110(13):1799-1805. doi:10.1161/01.CIR.0000142863.71285.74
McCullough PA, Duc P, Omland T, et al. B-type natriuretic peptide and renal function in the diagnosis of heart failure: an analysis from the Breathing Not Properly Multinational Study. Am J Kidney Dis. 2003;41(3):571-579. doi:10.1053/ajkd.2003.50118
Huang J, Guan H, Booze RM, Eckman CB, Hersh LB. Estrogen regulates neprilysin activity in rat brain. Neurosci Lett. 2004;367(1):85-87. doi:10.1016/j.neulet.2004.05.085
Guo Q, Zhang Q, He Y, Shi J, Li H, Peng H. Gender difference of association between plasma N-terminal pro-atrial natriuretic peptide and metabolic syndrome. Hormones (Athens). 2020;19(4):541-548. doi:10.1007/s42000-020- 00222-w
Hamada M, Shigematsu Y, Takezaki M, Ikeda S, Ogimoto A. Plasma levels of atrial and brain natriuretic peptides in apparently healthy subjects: Effects of sex, age and hemoglobin concentration. Int J Cardiol. 2017;228:599-604. doi:10.1016/j.ijcard.2016.11.197
Otaki Y, Watanabe T, Sato N, et al. Brain Natriuretic Peptide (BNP) and N-Terminal-proBNP in Cardio-Renal Anemia Syndrome　- Difference in Prognostic Ability. Circ Rep. 2019;1(2):71-77. Published 2019 Jan 22. doi:10.1253/circrep.CJ-18-0004
Sengenès C, Berlan M, De Glisezinski I, Lafontan M, Galitzky J. Natriuretic peptides: a new lipolytic pathway in human adipocytes. FASEB J. 2000;14(10):1345-1351.
Kalra PR, Tigas S. Regulation of lipolysis: natriuretic peptides and the development of cachexia. Int J Cardiol. 2002;85(1):125-132. doi:10.1016/s0167-5273(02)00241-3.

Details

Primary Language

English

Subjects

Nefroloji

Journal Section

Research Article

Authors

Mehmet Polat
0000-0003-1952-4237
Türkiye

Özgür Kılıç ^*
0000-0001-7194-8569
Türkiye

Publication Date

December 31, 2025

Submission Date

January 20, 2025

Acceptance Date

December 16, 2025

Published in Issue

Year 2025 Volume: 42 Number: 4

IZ

https://izlik.org/JA57LP99UM

Cite

RIS / Bibtex

APA

Polat, M., & Kılıç, Ö. (2025). NT-proBNP as a biomarker for fluid management in hemodialysis patients: Insights from CHF and Non-CHF subgroups. Deneysel Ve Klinik Tıp Dergisi, 42(4), 366-371. https://izlik.org/JA57LP99UM

AMA

1.Polat M, Kılıç Ö. NT-proBNP as a biomarker for fluid management in hemodialysis patients: Insights from CHF and Non-CHF subgroups. J. Exp. Clin. Med. 2025;42(4):366-371. https://izlik.org/JA57LP99UM

Chicago

Polat, Mehmet, and Özgür Kılıç. 2025. “NT-ProBNP As a Biomarker for Fluid Management in Hemodialysis Patients: Insights from CHF and Non-CHF Subgroups”. Deneysel Ve Klinik Tıp Dergisi 42 (4): 366-71. https://izlik.org/JA57LP99UM.

EndNote

Polat M, Kılıç Ö (December 1, 2025) NT-proBNP as a biomarker for fluid management in hemodialysis patients: Insights from CHF and Non-CHF subgroups. Deneysel ve Klinik Tıp Dergisi 42 4 366–371.

IEEE

[1]M. Polat and Ö. Kılıç, “NT-proBNP as a biomarker for fluid management in hemodialysis patients: Insights from CHF and Non-CHF subgroups”, J. Exp. Clin. Med., vol. 42, no. 4, pp. 366–371, Dec. 2025, [Online]. Available: https://izlik.org/JA57LP99UM

ISNAD

Polat, Mehmet - Kılıç, Özgür. “NT-ProBNP As a Biomarker for Fluid Management in Hemodialysis Patients: Insights from CHF and Non-CHF Subgroups”. Deneysel ve Klinik Tıp Dergisi 42/4 (December 1, 2025): 366-371. https://izlik.org/JA57LP99UM.

JAMA

1.Polat M, Kılıç Ö. NT-proBNP as a biomarker for fluid management in hemodialysis patients: Insights from CHF and Non-CHF subgroups. J. Exp. Clin. Med. 2025;42:366–371.

MLA

Polat, Mehmet, and Özgür Kılıç. “NT-ProBNP As a Biomarker for Fluid Management in Hemodialysis Patients: Insights from CHF and Non-CHF Subgroups”. Deneysel Ve Klinik Tıp Dergisi, vol. 42, no. 4, Dec. 2025, pp. 366-71, https://izlik.org/JA57LP99UM.

Vancouver

1.Mehmet Polat, Özgür Kılıç. NT-proBNP as a biomarker for fluid management in hemodialysis patients: Insights from CHF and Non-CHF subgroups. J. Exp. Clin. Med. [Internet]. 2025 Dec. 1;42(4):366-71. Available from: https://izlik.org/JA57LP99UM