PURPOSE: BNP(Brain Natriuretic Peptide) is a reliable, clinical confirmatory marker in patients undergoing aquapheresis
METHODS: Data was extracted by retrospective chart review of admissions with primary diagnoses of decompensated heart failure, including right and left ventricular failure, requiring Ultrafiltration(UF). IRB exemption was granted. All UF treatments were prescribed and managed by the Heart Failure Management Program practitioners at St Luke's Hospital and Health Network, Bethlehem, PA, using Aquapheresis by the Aquadex system between December 2008 and November 2010.
RESULTS: Among the 180 UF therapies, 109 therapies had BNP values drawn at the time of admission and prior to discharge. Due to the skewed distribution of both BNP values, the non-parametric Wilcoxon signed rank test was used to compare the difference between admission and discharge BNP. At discharge, 69.7% patients had decreased BNP vs. 30.3% patients who had increase in BNP. The difference in the percentage of patients with decreased versus increased BNP at discharge is statistically significant (z = 5.89, p <0.0001). The patients with increase in BNP post treatment were in Stage D Heart-Failure(HF) by ACC-AHA classification, had other co-morbid conditions and had significantly elevated BNP at baseline.
CONCLUSIONS: BNP is a valuable confirmatory marker of the clinical response of HF patients undergoing UF therapy if used in right setting.
CLINICAL IMPLICATIONS: Higher values of Plasma BNP are associated with worse outcomes and higher mortality in HF patients. The Heart Failure Society of America (HFSA) guidelines support use of UF as a treatment for patients with HF, who present with volume overload. Patients with advanced HF and associated renal failure do not demonstrate same decrease in BNP post UF therapy. Indeed, the increase in BNP in the setting of clinical improvement with improved volume status can serve as an important negative prognostic marker in this sub-group of patients
DISCLOSURE: The following authors have nothing to disclose: Deepakraj Gajanana, Prasanna Sugathan, Mahesh Aradhya, Santh Silparshetty, Hyma Polimera, Ellen Amedeo
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