natriuretic-peptide--brain and Hypovolemia

Dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, reduces cardiovascular death and worsening heart failure in patients with chronic heart failure and reduced ejection fraction. Early initiation during an acute heart failure (AHF) hospitalization may facilitate decongestion, improve natriuresis, and facilitate safe transition to a beneficial outpatient therapy for both diabetes and heart failure.. The objective is to assess the efficacy and safety of initiating dapagliflozin within the first 24 hours of hospitalization in patients with AHF compared to usual care.. The DICTATE-AHF trial will establish the efficacy and safety of early initiation of dapagliflozin during AHF across both AHF and diabetic outcomes in patients with diabetes.

Topics: Acute Disease; Benzhydryl Compounds; Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Disease Progression; Glucosides; Heart Failure; Hospital Mortality; Humans; Hyperglycemia; Hypoglycemia; Hypoglycemic Agents; Hypotension; Hypovolemia; Insulin; Natriuresis; Natriuretic Peptide, Brain; Patient Readmission; Peptide Fragments; Randomized Controlled Trials as Topic; Renal Insufficiency, Chronic; Sodium Potassium Chloride Symporter Inhibitors; Sodium-Glucose Transporter 2 Inhibitors; Treatment Outcome; Weight Loss

Topics: Aged; Aged, 80 and over; Biomarkers; Blood Pressure; Blood Proteins; Female; Humans; Hypotension; Hypovolemia; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prospective Studies; Renal Dialysis; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome

Hyponatremia (serum sodium < 135 mEq/L) is the most common electrolyte abnormality in hospital and has impact on patient morbidity and mortality. The accuracy of volume status assessment is a major problem for the treatment planning especially to discriminate mild hypovolemic from euvolemic patients.. To examine the relationship between plasma N-Terminal-pro-Brain Natriuretic Peptide (NT-pro-BNP) level and extracellular water (ECW) status during the treatment of hyponatremia, as well as the cut-off value of plasma NT-pro-BNP in the differential diagnosis of volume status in hypovolemic vs. euvolemic hyponatremic patients.. Hyponatremic patients without clinical hypervolemia in Rajavithi Hospital were divided into the hypovolemic group and the euvolemic group according to ECW volume determined by bioimpedance analysis (BIA). Serum sodium, plasma NT-pro-BNP and ECW were assessed at the beginning, at the half correction of hyponatremia and at the end of treatment.. Of the 26 patients, 18 (69.2%) were hypovolemic and 8 (30.8%) were euvolemic. Before treatment, NT-pro-BNP levels of the patients with hypovolemia was significantly lower than the patients with euvolemia [median (min, max)] (pg/mL) of hypovolemic vs. euvolemic group [114 (21, 6,803) vs. 1,509 (538, 8,541)] respectively (p < 0.001) and NT-pro-BNP levels change in the similar direction as ECW volume during the treatment. The best cut-off value of plasma NT-pro-BNP level to distinguish hypovolemic from euvolemic hyponatremia was 518 pg/ml with the sensitivity of 94.4% and the specificity of 100%.. Plasma NT-pro-BNP levels provide objective information with respection to volume status in hyponatremia patients and can be used in clinical diagnosis of hypovolemic vs. euvolemic hyponatremic hyponatremia.

Topics: Adult; Aged; Diagnosis, Differential; Female; Humans; Hyponatremia; Hypovolemia; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; ROC Curve

Hyponatremia and hypovolemia occur often after aneurysmal subarachnoid hemorrhage (SAH) and are associated with poor outcome. The authors investigated whether brain natriuretic peptide (BNP) is related to hypovolemia and hyponatremia after SAH and whether it can differentiate between hypovolemic and non-hypovolemic hyponatremia.. In 58 SAH patients, the authors daily measured serum BNP and sodium concentrations, and circulating blood volume by means of pulse dye densitometry, during the initial 10 days. For each patient, mean BNP concentrations were calculated until occurrence of the following events: hyponatremia (Na <130 mmol/l), hypovolemia (blood volume <60 ml/kg), and severe hypovolemia (blood volume <50 ml/kg). The median day of onset of each event was calculated. In patients without an event, the authors calculated and used for comparison the mean BNP concentration until the median day of onset of the particular event. Odds Ratio's (OR) for high versus low mean BNP concentrations (dichotomized on median values per event) were calculated for the occurrence of each event and adjusted for relevant baseline characteristics.. Patients with BNP above median more often had severe hypovolemia (adjusted OR 4.2, 95% confidence interval, CI 1.2-15.0) and showed a trend toward hyponatremia (adjusted OR 3.3, 95% CI 0.7-9.2). In the 12 hyponatremic patients, BNP could not differentiate between hypovolemic and non-hypovolemic hyponatremia.. High BNP concentrations are related to the occurrence of severe hypovolemia and possibly hyponatremia. These data do not support a role for BNP measurements to differentiate between hypovolemic and non-hypovolemic hyponatremia in SAH patients.

Topics: Biomarkers; Blood Volume; Diagnosis, Differential; Female; Humans; Hyponatremia; Hypovolemia; Male; Middle Aged; Natriuretic Peptide, Brain; Severity of Illness Index; Sodium; Subarachnoid Hemorrhage

Management of fluid homeostasis remains a major challenge in hemodialysis patients. We aimed to establish whether the cardiac strain marker B-type natriuretic peptide (BNP) could help to identify hypervolemic patients at increased risk of death.. BNP levels were determined before dialysis in the entire HD population at our institution (n = 57). IDWG and BNP were stratified above or below 1.5 kg or the median value, respectively. All patients were prospectively followed for 35 months. The influence of IDWG and BNP on mortality was assessed with a Cox proportional hazards model, adjusted for each other, as well as for demographics, comorbidities, cardiac function, residual diuresis, dialysis duration and efficiency and complications of renal failure.. Median BNP was 303 (135 - 692) and 21 (36%) patients displayed an average IDWG below 1.5 kg. During follow up a total of 25 (44%) patients died, 5 (26%) in the low IDWG group and 20 (53%) in the high IDWG group (adjusted hazard ratio (adjusted HR) 5.31 95% CI (1.47 - 19.1), p = 0.011). In the low BNP group 7 (25%) patients died and in the high BNP Group 18 (62%) patients died (adjusted HR 3.53 95 CI (1.37 - 9.09), p = 0.009). When both factors were considered simultaneously, patients with low BNP and low IDWG had an 11 times lower risk of death compared to patients with high BNP and high IDWG (HR. 0.08 95% CI (0.01 - 0.6129, p = 0.015).. BNP and IDWG are independent and incremental predictors of mortality in HD patients. These findings suggest that BNP guided fluid management could improve survival in these patients.

Topics: Aged; Biomarkers; Chi-Square Distribution; Female; Humans; Hypovolemia; Kidney Failure, Chronic; Male; Natriuretic Peptide, Brain; Predictive Value of Tests; Proportional Hazards Models; Prospective Studies; Renal Dialysis; Risk Factors; Statistics, Nonparametric; Survival Rate