Usefulness of determining the plasma atrial natriuretic peptide(hANP) level in CAPD patients. Target plasma hANP levels for preventing left ventricular hyertrophy.:Target plasma hANP levels for preventing left ventricular hypertrophy

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• We tried to establish 'optimal' plasma atrial natriuretic peptide (hANP) levels, in which left ventricular diastolic dysfunction were taken into consideration, in CAPD patients.The subjects consisted of 53 CAPD patients without pulmonary hypertension, pericardial effusion, moderate-to-severe impairment of left ventricular function, moderate-to-severe mitral or aortic regurgitation (mean age: 47.0 years, mean duration of CAPD: 41.2 months). CTR and plasma hANP level were measured 19 times on average over 12.5-25 months and the degree of left ventricular hypertrophy was estimated once by echocardiography.Patients were divided into four groups according to the grade of left ventricular hypertrophy and dilatation of left atrium (group A: IVST+PWT≤21; group B: 22≤IVST+PWT≤27, LAD≤34; group C: 22≤IVST+PWT≤27, LAD≥35; group D: 28≤IVST+PWT). The following results were obtained; 1. There was no significant difference in mean blood pressure. 2. Circulating blood volume proved to be within the normal range in all groups when, evaluated by measuring the diameter of the inferior vena cava. 3. In contrast to the absence of a significant difference between group B and C in IVST+PWT, there was a significant difference not only in LAD but also in LVM and LVDd. 4. CTR was significantly larger in group D than in groups A, B and C. The average plasma hANP levels were as follows; group A: 39.7pg/ml, B: 42.8pg/ml, C: 60.4pg/ml, D: 69.9pg/ml. The correlation between CTR and plasma hANP level was significant in groups A and B, but not in group C or D.These data suggested the usefulness of determining the plasma hANP level for assessment of 'optimal' circulating blood volume in CAPD patients with mild left ventricular hypertrophy, whose left ventricular diastolic dysfunction was hardly detected by increased CTR. We propose a target plasma hANP level of 40-50pg/ml for protection against hypertrophic cardiomyopathy by preventing preload, which can cause dilatation of the left atrium.

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社団法人 日本透析医学会 | 論文

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