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Brain natriuretic peptide is removed by continuous veno-venous hemofiltration in pediatric patients

^a Department of Pediatric Cardiology, Bambino Gesù Hospital, Rome, Italy
^b Department of Nephrology Dialysis and Transplantation, St Bortolo Hospital, Vicenza, Italy

*Corresponding author. Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Hospital, Piazza S. Onofrio 4, 00100, Rome, Italy. Tel.: +39 06 6859 2449.

E-mail address: zaccaria.ricci{at}fastwebnet.it (Z. Ricci).

We wanted to evaluate if brain natriuretic peptide (BNP) is cleared during continuous veno-venous hemofiltration (CVVH) sessions in children with congenital heart disease. A prospective observational single-center study was conducted in a post-cardiac surgery intensive care unit of the city children's hospital. Ten children requiring CVVH for acute kidney injury following cardiac surgery were enrolled. Seven of them were undergoing postoperative extracorporeal membrane oxygenation. BNP clearance was evaluated by the difference between pre-filter and post-filter BNP blood amount indexed to pre-filter BNP concentration. All CVVH treatments were performed with 0.6 m² polyacrylonitrile filter, in predilution setting, at a dose of 80 ml/kg/h. Troponin I and myoglobin levels were also measured and CVVH clearances of these markers calculated for comparison with BNP. A significant decrease in post-filter compared with pre-filter levels of BNP was shown in all 10 cases (P<0.01). Median BNP clearance was 35.6 (29–39.3) ml/min. Troponin I and myoglobin levels did not show any significant drop between pre- and post-filter values (P>0.05) and their clearance was significantly lower than BNP (P: 0.0004). A daily analysis of BNP levels showed a significant decrease of its blood concentration. BNP levels were significantly reduced after three and four days from CVVH start (P<0.05). During 80 ml/kg/h CVVH, utilizing polyacrylonitrile membranes, BNP is efficiently cleared from blood in a small cohort of pediatric post-cardiosurgical patients. In this situation, BNP absolute blood levels may be unpredictable.

Key Words: Brain natriuretic peptide; Continuous veno-venous hemofiltration; Congenital heart disease; Pediatric cardiac surgery

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eComment: Brain natriuretic peptide is removed by continuous veno-venous hemofiltration in pediatric patients

Leo A. Bockeria and Mikhail Yarustovsky
Interactive CardioVascular and Thoracic Surgery 2009 9: 36. [Full Text] [PDF]

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				L. A. Bockeria and M. Yarustovsky eComment: Brain natriuretic peptide is removed by continuous veno-venous hemofiltration in pediatric patients Interactive CardioVascular and Thoracic Surgery, July 1, 2009; 9(1): 36 - 36. [Full Text] [PDF]