대한신장학회

논문분류	춘계학술대회 초록집
제목	N-terminal Pro-B-type Natriuretic Peptide and Proadrenomedullin Reflect Volume Status among Patients on Hemodialysis and Peritoneal Dialysis
저자	Sihyung Park, Ga Hee Lee, Bong Soo Park, Yang Wook Kim, Tae Hoon No, Jung Sun Kang, Yu Sun Jeon, Kyubok Jin
출판정보	2015; 2015(1):
키워드	Volume status, Hemodialysis, Peritoneal􀀁dialysis
초록	Background: Although control of euvolemic state is a key parameter for cardiovascular mortality in dialysis patients, the question for biomarkers of volume excess continues. Body composition monitor (BCM; Fresenius Medical care) has been proven as a non-invasive and quantitative method for measuring intracellular and extracellular fluid spaces. In addition, N-terminal pro-B-type natriuretic peptide (NT-proBNP), myeloperoxidase, copeptin and proadrenomedullin are associated with cardiac dysfunction and systemic blood volume. Present study investigated the relationship between body fluid status and volume markers in dialysis patients. Methods: Cohorts of predialysis, hemodialysis (HD) and peritoneal dialysis (PD) patients and age- and gender-matched healthy Korean individuals were recruited in the study (N=80). In all patients BCM and standard echocardiography were performed. HD patients were measured at the midweek session before dialysis and PD patients were measured with a dry abdomen. Also NT-proBNP, myeloperoxidase, copeptin and proadrenomedullin as volume markers were measured. Clinical overhydration was defined as an overhydration-to-exracellular water ratio of >15%. Results: No difference was found the groups in terms of total body water, extracellular water and intracellular water. Overhydration and clinical overhydration were more prevalent in HD and PD patients compared to control and pre-D patients significantly. This was associated with significantly (p<0.001) higher NT-proBNP and proadrenomedullin levels in HD and PD patients than in the control and pre-D groups. However, no significant difference was found in levels of myeloperoxidase and copeptin in the study groups. Clinical overhydration was associated with cardiac dysfunction markers (LV mass index, LV dimension and ejection fraction, left atrial diameter and E/E´ ratio). In multivariate models, clinical overhydration was directly related to NT-proBNP and proadrenomedullin concentrations in the study population (r=0.454 [p<0.001] and r=0.505 [p<0.001], respectively). Conclusions: Taken together, these data suggest that NT-proBNP and proadrenomedullin levels increase in association with systemic blood volume in HD and PD patients with cardiovascular disease, in contrast, myeloperoxidase and copeptin are not volume markers.
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