ESPN 53rd Annual Meeting

ESPN 2021


 
Investigating N-terminal pro B-type natriuretic peptide concentrations in paediatric patients on haemodialysis
NABIL MELHEM 1 SARAH ROY 1 HEIDI RAMSEY 1 MANISH SINHA 1

1- EVELINA LONDON CHILDRENS HOSPITAL
 
Introduction:

N-terminal pro B-type natriuretic peptide (NT-proBNP) is a biological marker of ventricular dysfunction secondary to fluid overload. Few data describe NT-proBNP concentrations and its potential utility for intravascular fluid assessments in the paediatric haemodialysis population. We describe demographic and clinical associations of NT-proBNP concentrations in children on established haemodialysis (HD).

Material and methods:

Retrospective cohort study including all prevalent children on HD, with preserved cardiac function aged <18yrs between 2018 and 2019. Stepwise multiple regression analysis was performed to assess potential predictors of post-dialysis logNT-proBNP and repeated measures ANOVA performed to analyse change in concentrations from baseline to 3 and 6 months.

Results:

24 of 31 children [14 (58%) white-Caucasian], mean age 10.3±5.8yrs of whom 16 (67%) were boys; 8 (33%) had congenital abnormalities of kidneys and urinary tract with 16 (66.7%) polyuric and remainder oligo-anuric (<150ml per day) at baseline.

Amongst all participants, there were 161 post-HD measurements with median (IQR) NT-proBNP 2046 (794, 5275) ng/L and following log transformation normalised data with mean logNT-proBNP 3.34±0.58ng/L. 130 (80.7%) had an elevated of NT-proBNP defined as a concentration above 598ng/L as previously described in a non-renal population. Multiple regression analysis identified post-dialysis systolic BP z-score (β=0.15, P<0.01), haemoglobin (β=0.01, P<0.01) and non-White ethnicity (β=0.10, p=0.02) as positive predictors of logNT-proBNP, whilst residual urine output of >150mls (β=-0.28, P<0.01) was a negative predictor of logNT-proBNP concentrations in this population.

On longitudinal assessment, the mean logNT-proBNP at baseline, 3 and 6 months were 3.32±0.47ng/L, 3.23±0.55ng/L and 3.19±0.61ng/L respectively (p=0.50).

Conclusions:

Elevated NT-proBNP were observed in the majority of children on haemodialysis with preserved cardiac function with a dominant effect of blood pressure and residual urine output. These data demonstrate both modifiable and non-modifiable risk associations with higher NT-proBNP and highlight potential clinical relevance when fine-tuning the clinician’s intravascular fluid assessments for children on chronic haemodialysis.