Early Results Using N-Terminal pro-B-Type Natriuretic Peptide (pro-BNP) as a Biomarker for the Efficacy of Secondary Extension Technique (SET) in Improving Myocardial Function in Dialysis Patients With High Flow Fistulas

Author(s) Haque A. (adam.haque@manchester.ac.uk); Al-Khaffaf H.
Institution(s) (Haque, Al-Khaffaf) Cumbria and Lancashire Vascular and Endovascular Centre, East Lancashire Hospitals NHS Trust, Blackburn BB2 3HH, United Kingdom
Source Annals of Vascular Surgery; 2021
Language English
Database EMBASE
AbstractBackground: The association of dialysis fistulas and heart failure is believed to be due to high cardiac output. N-terminal pro-B-Type Natriuretic Peptide (pro-BNP) which is secreted by the cardiac ventricles in response to excessive stretching of the myocytes has been used as a marker of heart failure with 90% sensitivity. We report our early experience using pro-BNP levels to test the efficacy of the novel 'secondary extension technique' (SET) in improving myocardial function by reducing fistula flow. Method(s): Eleven patients with high fistula flows (>3000 mL/m, all brachio-cephalic) and raised pro-BNP underwent SET between 2011 and 2015. SET involves extending the anastomosis from brachial to either proximal radial or ulnar arteries. We measured pro-BNP levels, fistula flow and clinical improvements both pre and post operatively. Result(s): SET resulted in a median (IQR) flow rate decrease of 57.9 (11.9)% which correlated with a fall in pro-BNP of 69.6 (39)%. Seven of the 11 patients in the series pro-BNP level returned to a normal value at average follow-up of 3 months post SET. All patients had HOF-related symptom resolution post-procedure and remained asymptomatic at last follow-up Conclusion(s): Our pilot data suggests that SET is an effective way of reducing fistula flow. It also shows that BNP may be a reliable biomarker in assessing the impact of the technique on cardiac function. These results warrant further investigation in the form of a definitive, multicenter study.Copyright © 2021

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