Exploring the Relationship Among BNP, Fluid Status and Acute Kidney Injury in Critically Ill Patients

Exploring the Relationship Among Brain Natriuretic Peptide, Fluid Status and Acute Kidney Injury in Critically Ill Patients

B-type natriuretic peptide (BNP) is rapidly released by the ventricles of the heart in response to myocardial stretch. This cardiac neurohormone is mostly elevated in patients with fluid overload or myocardium dysfunction. BNP is a very useful and important marker. It can predict mortality and cardiac events in patients in the ICU setting. In stable hemodialysis patients with normal LV function on echocardiography, high BNP levels are likely the result of blood volume expansion and require reduction in postdialysis dry weight.

In the past, there were many methods to evaluate fluid status. Some are not reliable such as central venous pressure or physical examination. Some are invasive and expensive such as Swan Ganz、PiCCO catheter or bioimpedance device. Nevertheless, About the relationship between BNP and fluid status, a study found a significant relation between bioimpedance-derived body composition (BC) (fluid distribution) parameters and BNP concentrations. This relationship was independent of the cardiac history of the patient and suggests that the natriuretic peptide levels are to some degree modifiable by changing a patient's fluid distribution.

In this study, the investigators want to observe that if the level of BNP can predict the occurrence of acute kidney injury and the need of renal replacement therapy. Besides, the investigators also want to see if BNP can be a useful and convenient marker to guide adjustment of optimal fluid status and then to improve outcome.

Study Overview

• Status: Unknown
• Conditions: Acute Kidney Injury (Nontraumatic)

Detailed Description

B-type natriuretic peptide (BNP) is rapidly released by the ventricles of the heart in response to myocardial stretch. This cardiac neurohormone is mostly elevated in patients with fluid overload or myocardium dysfunction. BNP is a very useful and important marker. It can predict mortality and cardiac events in patients in the ICU setting. In stable hemodialysis patients with normal LV function on echocardiography, high BNP levels are likely the result of blood volume expansion and require reduction in postdialysis dry weight.

On the other hand, ample recent data have highlighted the role of fluid accumulation on mortality and non-recovery of kidney function in critically ill patients with acute kidney injury (AKI). In the past, there were many methods to evaluate fluid status. Some are not reliable such as central venous pressure or physical examination. Some are invasive and expensive such as Swan Ganz、PiCCO catheter or bioimpedance device. Nevertheless, About the relationship between BNP and fluid status, a study found a significant relation between bioimpedance-derived body composition (BC) (fluid distribution) parameters and BNP concentrations. This relationship was independent of the cardiac history of the patient and suggests that the natriuretic peptide levels are to some degree modifiable by changing a patient's fluid distribution.

In this study, we want to observe that if the level of BNP can predict the occurrence of acute kidney injury and the need of renal replacement therapy. Besides, we also want to see if BNP can be a useful and convenient marker to guide adjustment of optimal fluid status and then to improve outcome.

• Study Type: Observational
• Enrollment (Anticipated): 300

Contacts and Locations

• Study Contact: Name: yu-hsiang chou, bachelor; Phone Number: +886-2-23123456; Email: chouyuhsiang@yahoo.com.tw

Study Locations

• Taiwan
  • Taipei, Taiwan, 100
    • Recruiting
    • National Taiwan University Hospital
    • Contact: yu-hsiang chou, bachelor; Phone Number: +886-2-23123456; Email: chouyuhsiang@yahoo.com.tw

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Critically ill patients in intensive care unit(older than 18 y/o)

Description

Inclusion Criteria:

• Patients > 18 y/o in ICU

Exclusion Criteria:

• Acute coronary syndrome
• Congestive heart failure history
• Clinical pulmonary hypertension with various cause (iPAH, congenital heart disease, CTEPH, COPD with cor pulmonate,…)
• Patients with acute pulmonary embolism
• Chronic atrial fibrillation,
• Respiratory failure with high PEEP (>10 CmH2)
• Terminal cancer patients
• Patients with Bosmina therapy
• Patients received CPR (IHCA or OHCA)

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Acute kidney injury; ICU patients with Acute kidney injury

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Change from Baseline in serum creatinine level at 3 months	3 months

Secondary Outcome Measures

Outcome Measure	Time Frame
Mortality	1 year

Collaborators and Investigators

• Sponsor: National Taiwan University Hospital
• Investigators: Study Director: Yu-Hsiang Chou, bachelor, National Taiwan University Hospital

Study record dates

Study Major Dates

• Study Start: January 1, 2012
• Primary Completion (Anticipated): December 1, 2014
• Study Completion (Anticipated): December 1, 2014

Study Registration Dates

• First Submitted: March 10, 2014
• First Submitted That Met QC Criteria: March 20, 2014
• First Posted (Estimate): March 24, 2014

Study Record Updates

• Last Update Posted (Estimate): March 24, 2014
• Last Update Submitted That Met QC Criteria: March 20, 2014
• Last Verified: March 1, 2014

More Information

Terms related to this study

• Keywords: BNP, acute kidney injury, fluid status
• Additional Relevant MeSH Terms: Kidney Diseases; Urologic Diseases; Renal Insufficiency; Wounds and Injuries; Acute Kidney Injury
• Other Study ID Numbers: 201111012RIB