Bioimpedance and serum N-terminal pro-B-type natriuretic peptide in determination of dry body weight and chronic inflamation in hemodialysis patients

Abstract

Cilj istraživanja: Osnovni cilj ovog istraživanja bio je ispitati postojanje povezanosti između serumske razine NT-proBNP s bioimpendancijskom procjenom viška tjelesne vode i njihov odnos s upalnim indeksom mjerenog omjerom CRP i serumskog albumina (Glasgow prognostički indeks, GPI). Nacrt studije: Istraživanje je presječna studija. Ispitanici i metode: Istraživanje je provedeno na 30 bolesnika sa završnim stadijem kronične bubrežne bolesti na kroničnom programu hemodijalize. Za određivanje viška tjelesne vode korištena je metoda bioimpendancijske spektroskopije. Iz rezultata redovitog laboratorija preuzete su informacije o biljezima upale, CRP i albumin. Iz prosječnih šestomjesečnih koncentracija CRP-a i serumskog albumina određen je Glasgow prognostički indeks. Prije i poslije hemodijalize određene su serumske razine NT-proBNP-a. Rezultati: Istraživanje je provedeno na 30 bolesnika, od kojih je 17 muškaraca i 13 žena. Najviše ispitanika prema osnovnoj bubrežnoj bolesti boluje od dijabetičke nefropatije, njih 13. Ispitanici u skupini s dokazanom bolesti srca su starije životne dobi te imaju više prosječne vrijednosti Glasgow prognostičkog indeksa. Bolesnici normalne tjelesne mase imaju značajno više vrijednosti NT-proBNP i u prvom i u drugom mjerenju. U svih bolesnika NT-proBNP je u korelaciji s GPI i s izmjerenim viškom tjelesne vode. Pozitivna korelacija NT-proBNP s GPI i sa OH izraženija je u srčanih bolesnika. OH je u korelaciji je s GPI u svih ispitanika. Pozitivna korelacija OH s GPI izraženija je u srčanih bolesnika. Zaključak: NT-proBNP je povezan s volumnim opterećenjem, srčano-žilnim bolestima ali i s kroničnom upalom u bolesnika liječenih hemodijalizom. Kronična upala je povezana s volumnim opterećenjem.Objective: The aim of this study was to investigate the correlation between NT-proBNP serum levels, Glasgow prognostic index determined by CRP and serum albumin and bioimpendance estimation of excess body water in patients treated with hemodialysis. Study design: The study is structured as a cross-section study. Participants and methods: The study included 30 patients with end stage chronic renal disease in chronic hemodialysis program at Clinic of Nephrology at Clinical Hospital Center Osijek. To determine the excess of body water, ie dry body mass, the method of bioimpendance spectroscopy was used. The body composition was determined before dialysis using the portable whole-body multifrequency bioimpedance analysis device (Body Composition Monitor–BCM). Serum levels of NT-proBNP were determined before and after the hemodialysis. The six-month average serum levels of inflammation markers, CRP and albumin, were determined from the results of regular laboratory testing. Results: The study was conducted on 30 patients, of whom 17 were men and 13 were women. The mean value of the patient age is 67.5 years, ranging from 34 to 89 years. Subjects in the group with proven heart disease were found to be older and have a higher Glasgow prognostic index values. Patients with normal body mass have showed significantly higher NT-proBNP values in both the first and the second measurement. In all patients, NT-proBNP levels showed significant correlation with Glasgow prognostic index and bioimpendently measured excess body water. The positive correlation of NT-proBNP with GPI and overhydration was more pronounced in cardiac patients. Overhydration was associated with GPI in all subjects. Also, we found the association to be more pronounced in cardiac patients. Conclusion: NT-proBNP is associated with volume load, cardiovascular disease as well as chronic inflammation in patients treated with hemodialysis. Chronic inflammation is associated with excess body water