Early Results Using N-Terminal pro-B-Type Natriuretic Peptide (pro-BNP) as a Biomarker for the Efficacy of Secondary Extension Technique (SET) in Improving Myocardial Function in Dialysis Patients With High Flow Fistulas
| Autor: | Haytham Al-Khaffaf, Adam Haque |
|---|---|
| Rok vydání: | 2022 |
| Předmět: |
Cardiac function curve
medicine.medical_specialty Fistula medicine.drug_class medicine.medical_treatment Anastomosis Asymptomatic Renal Dialysis Internal medicine Natriuretic Peptide Brain medicine Natriuretic peptide Humans Dialysis business.industry General Medicine medicine.disease Peptide Fragments Treatment Outcome Heart failure cardiovascular system Cardiology Biomarker (medicine) Surgery medicine.symptom Cardiology and Cardiovascular Medicine business Biomarkers |
| Zdroj: | Annals of Vascular Surgery. 81:267-272 |
| ISSN: | 0890-5096 |
| Popis: | Objectives The association of dialysis fistulas and heart failure is believed to be due to high cardiac output. N-terminal pro-B-Type Natriuretic Peptide (pro-BNP) which is secreted by the cardiac ventricles in response to excessive stretching of the myocytes has been used as a marker of heart failure with 90% sensitivity. We report our early experience using pro-BNP levels to test the efficacy of the novel ‘secondary extension technique’ (SET) in improving myocardial function by reducing fistula flow. Methods 11 patients with high fistula flows (>3000ml/m, all brachio-cephalic) and raised pro-BNP underwent SET between 2011 and 2015. SET involves extending the anastomosis from brachial to either proximal radial or ulnar arteries. We measured pro-BNP levels, fistula flow and clinical improvements both pre and post operatively. Results SET resulted in a median (IQR) flow rate decrease of 57.9 (11.9) % which correlated with a fall in pro-BNP of 69.6 (39) %. 7 of the 11 patients in the series pro-BNP level returned to a normal value at average follow-up of 3 months post SET. All patients had HOF-related symptom resolution post-procedure and remained asymptomatic at last follow-up Conclusion Our pilot data suggests that SET is an effective way of reducing fistula flow. It also shows that BNP may be a reliable biomarker in assessing the impact of the technique on cardiac function. These results warrant further investigation in the form of a definitive, multicentre study. |
| Databáze: | OpenAIRE |
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