The target range of plasma ANP level for dry weight adjustment in HD patients

DOI 2 Citations 14 References
  • Ishii Eriko
    Division of Nephrology, Department of Internal Medicine, Jichi Medical School
  • Ando Yasuhiro
    Division of Nephrology, Department of Internal Medicine, Jichi Medical School
  • Yamamoto Hisashi
    Division of Nephrology, Department of Internal Medicine, Jichi Medical School
  • Kotohda Keisuke
    Koganei Clinic
  • Asano Yasushi
    Division of Nephrology, Department of Internal Medicine, Jichi Medical School
  • Kusano Eiji
    Division of Nephrology, Department of Internal Medicine, Jichi Medical School

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  • 血液透析（ＨＤ）患者の血中心房性ナトリウム利尿ペプチド（ＡＮＰ）値によるドライウェイト（ＤＷ）の判断基準に関する検討

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Plasma ANP (atrial natriuretic peptide), a parameter of blood volume, is a tool for determination of dry weight (DW) in hemodialysis (HD) patients. However, its definite quantitative criteria has not been established. Especially, the ANP level corresponding to hypovolemia remains unclear. In the present study, we explored the correlation between plasma ANP level and DW in HD patients to develop a concrete guideline for DW adjustment. Post-HD plasma ANP was measured in 58 HD patients, in whom DW had been determined by conventional methods, such as cardio-thoracic ration (CTR) on chest xp, physical examination and blood pressure. Patients were divided into three groups, i.e., hypovolemic, euvolemic and hypervolemic group according to subjective symptoms and objective clinical observation. Post-HD ANP level reported significant differences among the three groups (hypovolemic group: 35.5±5.98pg/mL, euvolemic group: 57.4±4.42pg/mL, hypervolemic group: 137.8±22.7pg/mL). The 10 to 90 percentile of post-HD ANP level in euvolemic group distributed between 25 and 100pg/mL, when post-HD ANP was between 40 and 60pg/mL, the median range in euvolemic group, the possibility that the DW is appropriate was as high as 95.8%. In contrast, when post-HD ANP was over 100pg/mL or below 25pg/mL, the potential for DW to be appropriate was as low as 42.9% and 29.2%, respectively. We concluded that 40-60pg/mL is the target range for post-HD ANP to attain an appropriate DW, and an ANP level over 100pg/mL or below 25pg/mL implies the need for readjustment of DW.

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