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

Year 2025, Volume: 42 Issue: 4, 366 - 371, 31.12.2025

Mehmet Polat , Özgür Kılıç

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

Volume overload , hemodialysis , congestive heart failure , fluid balance N-terminal pro-brain natriuretic peptide

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.

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