The brain natriuretic peptide (BNP) is synthesized and released by cardiomyocytes in response to increased transmural wall stress. It is produced by ventricular myocytes as circulating propeptide (proBNP) and further processed to N-terminal proBNP (NT-proBNP). The increase plasma NT-proBNP concentration may be useful indicator for asymptomatic left ventricular dysfunction. This phenomenon is very important particularly in patients with end-stage renal disease, because heart failure is a leading cause of their death.

The aim of this study was assessing the NT-proBNP plasma concentration and finding the influencing factors on its plasma concentration in patients treated with maintenance haemodialysis (mHD).

Studies were taken on 66 mHD patients (mean duration of HD 47.35±37.12 months), 20 of them suffered from coronary artery disease. HD procedures were performed 3 times a week for 4 hours with polysulphone capillary dialyzers with a regiment of i.v. iron (112.52±15.25 mg per week) and i.v. rHuEPO (5392.85±3234.35 IU per week). Blood samples were drawn from fasting patients at the start of the second HD of the week. Reference values were obtained from 20 healthy volunteers (HV).

NT-proBNP and soluble transferrin receptor (sTfR) concentrations were assessed by ELISA method. The concentrations of selected hematological variables (RBC, HCT, HGB), total cholesterol, LDL-cholesterol, triglycerides (TG) and creatinine were evaluated by the routine laboratory tests.

In mHD patients plasma concentration of NT-proBNP (152.2±68.6 fmol/ml) and sTfR (1.54±0.84 mg/ml) were significantly higher (p<0.05) in comparison to HV: NT-proBNP (35.6±21.3 fmol/ml) and sTfR (0.71±0.84 mg/ml). The values of RBC, HCT, HGB in serum were significantly (p<0.0001) lower in mHD than in HV group. Total cholesterol, LDL-cholesterol and TG were slightly (with no statistical significance (p=0.07)) decreased in mHD. The positive correlations between NT-proBNP and the presence of the coronary artery disease (r=0.19, p=0.01), duration of HD treatment (r=0.31, p<0.0001) and creatinine serm concentration (r=0.31, p<0.0001) were observed. Plasma concentration of NT-proBNP inversely correlated with total cholesterol (r=-0.55, p<0.0001), LDL cholesterol (r=-0.5, p<0.0001), RBC (r=-0.36, p=0.006) and HGB (r=0.041, p=-0,274). Between NT-proBNP and sTfR, TG no significant correlations were revealed.

Studied patients, especially those with coronary artery disease shoved the propensity to the high plasma NT-proBNP concentration The concentration of this parameter may be influenced by the duration of HD treatment and serum creatinine concentration. It is probably because it is cleared from plasma by renal secretion. The inverse correlations between NT-proBNP, selected haematological and lipids parameters suggest that anaemia and malnutrition, atherosclerosis and inflammation syndrome may be another factor influencing NT-proBNP.

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