Assessment of Relationship Between Plasma BNP Concentration and Cardiac Function in Hemodialysis Patients with Diabetes Mellitus

Abstract

Diabetic patients with chronic renal failure (CRF) have been reported to start hemodialysis (HD) earlier than non-diabetic patients with CRF, because cardiovascular complications frequently appeared and the main cause of death in diabetic patients was the cardiovascular events in the former. In order to assess whether the plasma brain natriuretic peptide (BNP) concentration would be a predictor of cardiac dysfunction, we examined the relationship between plasma BNP concentrations and cardiac functions estimated by M-mode echocardiography in diabetic patients maintained on HD. Plasma BNP levels were significantly higher (818.6 ± 21.6 pg/ml) than normal limits (～20 pg/ml) before HD, and during HD the levels were still high (748.7 ± 21.0 pg/ml). Pre-HD BNP levels did not correlate with clinical parameters such as age, HD duration, mean blood pressure, weight change, cardiothoratic ratio and HbAlc, but did correlate with the duration of diabetes mellitus. Moreover, pre-HD BNP levels correlated with ejection fraction (r=0.415, p<0.05) and left ventricular mass index (r=0.568, p<0.01). In diabetic patients undergoing HD, long durations of hyperglycemia and chronic cardiac load increase in left ventricular mass, resulted in higher levels of plasma BNP levels. Taken together, plasma BNP levels may be a predictor of cardiac dysfunction in diabetic patients undergoing HD.