• Nan Hu, Jinwei Wang, and Yuqing Chen.
• Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China.
• Postgrad Med J. 2024 Oct 4.

PurposeThe objective of this study was to elucidate the spectrum of brain natriuretic peptide (BNP) expression in hemodialysis patients with euvolemic status and investigate its prognostic significance.MethodsPatients on chronic hemodialysis were enrolled. The normal range of BNP was measured and analyzed in patients with euvolemic status defined by systolic blood pressure and overhydration. Hemodialysis patients were stratified into groups according to BNP expression at baseline and followed up for 57 months, with all-cause mortality and cardiovascular disease-related death being assessed as primary outcomes.ResultsBNP significantly correlated with overhydration in all patients (r = 0.255, P = .004). In patients with euvolemic state, the average BNP level was 701 (±645) pg/ml, with a 95% confidence interval (CI) of 500-902 pg/ml. In patients with BNP < 902 pg/ml, systolic blood pressure significantly correlated with overhydration. Elevated BNP expression correlated with an increased risk of cardiovascular mortality (HR = 1.871, per 782 pg/ml increase, P = .008). The patients with continuously high levels of BNP showed significantly increased risk of cardiovascular disease-related death during follow-up (HR = 12.845, P = .005).ConclusionPredialysis measured BNP levels correlate with volume status, and the common range is from 500 to 902 pg/ml in dialysis patients with euvolemic status. Patients with upregulated BNP expression showed an increased risk of cardiovascular death. Key messages What is already known on this topic  The volume management of hemodialysis patients should be judged comprehensively by clinical manifestations and objective examinations. The parameters involved in the evaluation need to be further optimized. What this study adds  In hemodialysis patients, BNP serves as an indicator of volume status. Properly hydrated hemodialysis patients typically exhibit BNP levels ranging from 500 to 902 pg/ml, while persistent BNP elevation is associated with increased mortality. How this study might affect research, practice, or policy  In clinical practice, BNP can be routinely monitored in hemodialysis patients to provide information for volume adjustment and to identify patients with high mortality risk. The potential advantages of implementing targeted BNP management warrant further investigation through intervention studies.© The Author(s) 2024. Published by Oxford University Press on behalf of Fellowship of Postgraduate Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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