Clinical significance of natriuretic peptides and cyclic GMP in hemodialysis patients with coronary artery disease

Background: Plasma concentrations of atrial natriuretic peptide (ANP), brai n natriuretic peptide (BNP) and cyclic guanosine monophosphate (cGMP) are s uitable markers of 'dry body weight' (DW) in hemodialysis (HD) patients. Ho wever, it is still unknown whether these markers can be applied to patients with renal failure and coronary artery disease (CAD). We examined the reli ability of these peptides as volume markers in HD patients with CAD. We als o assessed the relationship between natriuretic peptides and indices of lef t ventricular (LV) function. Methods: Plasma concentrations of ANP, BNP and cGMP were determined before and after HD in patients with CAD (group 1, n = 19, mean age 63 +/- 12 years) and were compared with those of patients wi thout cardiac disease (group 2, n = 20, age 61 +/- 15 years). Using data ob tained by cardiac catheterization, we examined the relationship between nat riuretic peptides and indices of LV function in HD patients with CAD. Resul ts: Baseline ANP (244 +/- 205 pg/ml), BNP (713 +/- 928 pg/ml) and cGMP (29. 6 +/- 21.6 pmol/ml) were significantly higher in group 1 than in 11 healthy volunteers (18.6 +/- 9.9 pg/ml, 7.7 +/- 7.6 pg/ml, cGMP 8.9 +/- 4.9 pmol/m l, respectively). HD significantly reduced plasma ANP (87 +/- 75 pg/ml) and BNP (477 +/- 702 pg/ml) although they were still above normal control. HD reduced plasma cGMP (7.2 +/- 4.5 pmol/ml) to normal values, suggesting the elimination of cGMP across the dialyzers. Baseline levels of ANP, BNP and c GMP in group 2 were less than those of group 1 but higher than the control. HD reduced natriuretic peptides in group 2 to levels lower than those in p ost-HD group 1. After HD, there was no significant correlation between redu ctions in body weight and changes in ANP or BNP. Baseline ANP and BNP level s closely correlated with pulmonary artery pressure, pulmonary artery wedge pressure, left ventricular end-diastolic pressure and left ventricular eje ction fraction. A significant correlation was observed between BNP levels a nd the severity of CAD. Conclusion: ANP, BNP and cGMP seem to be a useful m arkers for fluid overload but not for DW in HD patients with CAD. Plasma AN P and BNP might be useful markers for left ventricular function. Copyright (C) 2001 S. KargerAG, Basel.