ESPN 54th Annual Meeting

ESPN 2022


 
Benefits of BNP/NT-pro-BNP serum level evaluation for dry weight adjustment in paediatric haemodialysis patients
ANTOINE MOUCHE 1 CYRIELLE PARMENTIER 1 FATMA FENDRI 1 CLAIRE HERBEZ-REA 1 THERESA KWON 2 LAURENE DEHOUX 3 JEAN-DANIEL DELBET 1 TIM ULINSKI 1

1- HOPITAL TROUSSEAU, PARIS (APHP)
2- HOPITAL DEBRE, PARIS (APHP)
3- HOPITAL NECKER, PARIS (APHP)
 
Introduction:

Dry weight (DW) adjustment in children on haemodialysis (HD) can be challenging. It relies on clinical evaluation and additional supports. Our aim was to study the benefits of cardiac biomarkers assessment, in addition to the more commonly used technique bioimpedance spectroscopy (BIS) and clinical signs for DW prescription in paediatric HD patients.

Material and methods:

Prospective observational study including 41 children on HD in three paediatric HD centres in the Paris region. During one session, BIS was performed before the session and serum levels of BNP and NT-proBNP were analysed before and after the session.

Results:

Median pre-dialysis level of BNP was 87 ng/L [24–192] and NT-proBNP 968 ng/L [442–4828]. Cardiac biomarkers levels showed positive correlation with the BIS hydration status evaluation (p=0.004). The most appropriate cut-off for pre-dialysis BNP to detect significant overhydration (OH) was 165 ng/L (sensibility 0.67, specificity 0.84). Based on the BIS evaluation, only 32% of patients with high blood pressure (BP) had OH, whereas in the normal BP group, 33% had significant OH. 

Conclusions:

DW prescription for children on HD should not only rely on clinical evaluation, particularly BP, and should include additional helpful parameters. BIS is well validated in children, but it has limitations in non-cooperative patients. Cardiac biomarkers, especially BNP, have proven in this study to be well correlated to hydration status evaluated by BIS, and thus could add precious informations for individual patient management and dry weight assessment.