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Natriuretic peptides, extracellular volume, and subclinical cardiovascular changes in chronic kidney disease stages 1–3: a pilot study

L Parker Gregg, Peter N Van Buren, David J Ramsey, Amaris Maydon, Subhash Banerjee, Carl P Walther, Salim S Virani, Wolfgang C Winkelmayer, Sankar D Navaneethan, S Susan Hedayati
DOI: 10.1136/jim-2022-002467 Published 19 July 2022
L Parker Gregg
1Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
2Medical Care Line, Section of Nephrology, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
3Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA
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Peter N Van Buren
4Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
5Medical Service, Renal Section, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA
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David J Ramsey
3Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA
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Amaris Maydon
6Mental Health Service, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA
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Subhash Banerjee
7Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
8Medical Service, Cardiology Section, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA
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Carl P Walther
1Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Salim S Virani
3Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA
9Internal Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
10Internal Medicine, Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
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Wolfgang C Winkelmayer
1Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Sankar D Navaneethan
1Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
2Medical Care Line, Section of Nephrology, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
3Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA
11Institute of Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, USA
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S Susan Hedayati
4Internal Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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  • Figure 1
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    Figure 1

    CKD was associated with higher pulse pressure, lower cardiac index, and higher peripheral resistance. Dot plots show the individual data points for BNP (A), NT-pro-BNP (B), systolic blood pressure (C), diastolic blood pressure (D), pulse pressure (E), ECW/total body weight (F), cardiac index (G), and TPRI (H). BNP, brain natriuretic peptide; BP, blood pressure; CKD, chronic kidney disease; ECW, extracellular water; NT-pro-BNP, amino terminal pro-BNP; TPRI, total peripheral resistance index.

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    Figure 2

    BNP and NT-pro-BNP were associated with cardiovascular parameters. Scatter plots show the linear associations of BNP with pulse pressure (A), cardiac index (B), and TPRI (C) and of NT-pro-BNP with pulse pressure (D) and cardiac index (E). Natriuretic peptides and blood pressure values were measured the same day as the available cardiac index and total peripheral resistance index measurement for each participant. BNP, brain natriuretic peptide; CKD, chronic kidney disease; NT-pro-BNP, amino terminal pro-BNP; TPRI, total peripheral resistance index. *p<0.05, **p<0.01.

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    Figure 3

    Higher systolic blood pressure and diastolic blood pressure and higher peripheral resistance may be associated with multiple patient-reported symptoms. In an exploratory analysis, the heat map represents correlations seen between symptom scores and cardiovascular parameters, with bright red representing the strongest positive correlations and bright blue representing the strongest negative correlations. Pale red and pale blue represent weaker correlations, and gray represents correlations near zero. Patient-reported symptoms, ECW/total body weight, and blood pressure were measured the same day as the available cardiac index and total peripheral resistance index measurement for each participant. CKD, chronic kidney disease; ECW, extracellular water; FACIT-F, Functional Assessment of Chronic Illness Therapy-Fatigue; KDQOL, Kidney Disease Health Related Quality of Life-Short Form 36; QIDS-SR16, 16-item Self-Reported Quick Inventory of Depressive Symptomatology; TPRI, total peripheral resistance index.

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    Figure 4

    Repeated measurements of natriuretic peptides and extracellular volume were consistent over time. BNP (A), NT-pro-BNP (B), and ECW/total body weight (C) were consistent within participants from baseline to follow-up 4 weeks later. BNP, brain natriuretic peptide; CKD, chronic kidney disease; ECW, extracellular water; NT-pro-BNP, amino terminal pro-BNP.

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  • Table 1

    Baseline characteristics by CKD status

    Variable description, median (IQR) or N (%)Non-CKD
    N=8
    CKD
    N=13
    P value
    Estimated GFR, mL/min/1.73 m292 (84–99)40 (35–57)<0.001
    Age, years56.5 (48.0–72.5)70.0 (58.5–75.0)0.38
    Race  0.67
     Black4 (50.0)8 (61.5) 
     White4 (50.0)5 (38.5) 
    Hispanic ethnicity1 (12.5)0 (0.0)0.38
    Diabetes3 (37.5)8 (61.5)0.39
    Hypertension8 (100.0)13 (100.0)N/A
    Hyperlipidemia5 (62.5)12 (92.3)0.25
    Heart failure with preserved ejection fraction0 (0.0)2 (15.4)0.51
    Peripheral vascular disease1 (12.5)3 (23.1)1.00
    Depression5 (62.5)5 (38.5)0.39
    Tobacco use   
     Any history of tobacco use5 (62.5)9 (69.2)1.00
     Current tobacco use2 (25.0)5 (38.5)0.66
    Body weight, kg104.5 (76.8–112.7)90.6 (71.6–125.3)1.00
    Edema on physical examination2 (25.0)9 (69.2)0.08
    • .CKD, chronic kidney disease; GFR, glomerular filtration rate; IQR, interquartile range; N/A, not applicable.

  • Table 2

    Baseline symptom scores by CKD status

    Variable description, median (IQR)Non-CKD
    N=8
    CKD
    N=13
    P value
    Dyspnea*0.0 (0.0–2.4)1.0 (0.0–5.0)0.39
    Fatigue†24.0 (18.0–43.0)28.0 (24.0–43.0)0.38
    Depression‡6.0 (3.0–12.5)8.0 (3.5–13.0)0.49
    Quality of life§
     Symptom burden73.9 (57.8–90.3)65.9 (52.3–77.3)0.29
     Effect of CKD98.4 (73.4–100.0)93.8 (53.1–100.0)0.30
     Burden of CKD100.0 (70.3–100.0)75 (21.9–84.4)0.05
     Work50.0 (0.0–100.0)50.0 (0.0–100.0)0.70
     Cognitive function76.7 (53.3–96.7)80.0 (26.7–93.3)0.51
     Social73.3 (51.7–86.7)66.7 (36.7–93.3)0.94
     Sex37.5 (28.1–84.4)93.8 (40.6–100.0)0.45
     Sleep66.3 (40.6–71.9)57.5 (37.5–72.5)0.66
     Social support66.7 (33.3–83.3)50.0 (41.7–100.0)0.80
     Physical functioning42.5 (22.5–83.8)45.0 (17.5–70.0)0.80
     Role physical12.5 (0.0–93.8)0.0 (0.0–100.0)1.00
     Pain45.0 (22.5–56.9)32.5 (22.5–67.5)0.94
     General health47.5 (36.3–67.5)30.0 (22.5–57.5)0.17
     Emotional69.0 (57.0–82.0)64.0 (44.0–86.0)0.54
     Role emotional66.7 (0.0–100.0)66.7 (0.0–100.0)0.69
     Social functioning50.0 (50.0–87.5)50.0 (37.5–100.0)0.80
     Fatigue37.5 (16.2–67.5)40.0 (30.0–72.5)0.47
    • *Measured using the dyspnea visual analog scale, range 0–10. Higher scores indicate more severe dyspnea.

    • †Measured using the Functional Assessment of Chronic Illness Therapy-Fatigue, range 0–52. Higher scores indicate less severe fatigue.

    • ‡Measured using the 16-item Self-Reported Quick Inventory of Depressive Symptomatology, range 0–48. Higher scores indicate more severe depression.

    • §Measured using the Kidney Disease Health Related Quality of Life-Short Form 36, range 0–100. Higher scores indicate more favorable quality of life.

Supplementary Materials

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  • Supplementary data

    [jim-2022-002467supp001.pdf]

Additional Files

  • Figures
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  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    • Data supplement 1
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Natriuretic peptides, extracellular volume, and subclinical cardiovascular changes in chronic kidney disease stages 1–3: a pilot study
L Parker Gregg, Peter N Van Buren, David J Ramsey, Amaris Maydon, Subhash Banerjee, Carl P Walther, Salim S Virani, Wolfgang C Winkelmayer, Sankar D Navaneethan, S Susan Hedayati
Journal of Investigative Medicine Jul 2022, jim-2022-002467; DOI: 10.1136/jim-2022-002467

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Natriuretic peptides, extracellular volume, and subclinical cardiovascular changes in chronic kidney disease stages 1–3: a pilot study
L Parker Gregg, Peter N Van Buren, David J Ramsey, Amaris Maydon, Subhash Banerjee, Carl P Walther, Salim S Virani, Wolfgang C Winkelmayer, Sankar D Navaneethan, S Susan Hedayati
Journal of Investigative Medicine Jul 2022, jim-2022-002467; DOI: 10.1136/jim-2022-002467
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Natriuretic peptides, extracellular volume, and subclinical cardiovascular changes in chronic kidney disease stages 1–3: a pilot study
L Parker Gregg, Peter N Van Buren, David J Ramsey, Amaris Maydon, Subhash Banerjee, Carl P Walther, Salim S Virani, Wolfgang C Winkelmayer, Sankar D Navaneethan, S Susan Hedayati
Journal of Investigative Medicine Jul 2022, jim-2022-002467; DOI: 10.1136/jim-2022-002467
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