The relationship between the hypertensive retinopathy and plasma BNP levels of the patients receiving peritoneal dialysis because of the end-stage renal failure

PURPOSE: To investigate the relationship between hypertensive retinopathy and plasma BNP levels of the ESRD patients receiving peritoneal dialysis. MATERIALS AND METHODS: 29 patients receiving PD because of ESRD and the 29 patients as the control groups enrolled in the study. Patients' age, gender, dialysis duration, duration of CRF, diyastoic and systolic blood pressure, urine output were recorded. All patients' visual acuity, intraocular pressure, and fundus examination was performed. Keith, Wagener and Barker classification of hypertensive retinopathy were evaluated at the fundus examination. In addition, NT-proBNP levels were measured in blood samples. NT-proBNP levels were studied at the Immulite 2000 hormones analyzer device at the Biochemistry Laboratory of Inonu University Medical Faculty Hospital. As the method, the chemiluminescence was used from the immunoassay methods RESULTS: 29 patients receiving PD due to ESRD, with the mean age 53±15,7 years, was evaluated. Average of 5 years (3-20 years) with the diagnosis of chronic renal failure patients were receiving PD treatment for an average of 4 years (7 months to 14 years) because to the CRF. Average amount of urine was 400cc (0-1500cc). Also in the patient group the systolic blood pressure was measured 140 ± 24 mmHg and diastolic blood pressure was measured 80 ± 13 mmHg, respectively. Between patient and control groups did not differ significantly in terms of age and gender. BNP levels were detected significantly different between the patients and the control group. The plasma NT-proBNP levels of the control group was 42.80 (20-468) pg/ml while it was 5921 (300-35000) pg/ml in peritoneal dialysis patients, respectively. The study included 58 eyes of 29 patients with peritoneal dialysis which were divided into 3 groups according to the hypertensive retinopathy. Group 1, non-hypertensive retinopathy, Group 2, with grade I hypertensive retinopathy, Group 3, was composed of patients with grade II hypertensive retinopathy. There was no significant difference between the groups in age, sex, duration of CRF, the amount of urine, and systolic blood pressures. The dialysis duration of the Group 1, 2 and 3 was 6 ± 4 years, 5 ± 4 years, 3 ± 2 years, respectively. Group 1 had the longest duration of dialysis, , while in group 3 duration of dialysis were the shortest. There was no significant differences between Group 1 and 3 and also between Group 2 and 3 in terms of the duration of dialysis. Groups diastolic blood pressures were 76 ± 11 mmHg, 77 ± 11 mmHg, 90 ± 14 mmHg, respectively. There was statistically significant differences indicated between the diastolic blood pressures of the groups 2 and 3. The BNP levels of the Groups 1,2 and 3 was 1854, 2775 and 10,565, respectively. The BNP level was indicated the lowest in Group 1 and the highest in the group 3. There was no statistically significant difference between the groups in terms of NT-proBNP levels. CONCLUSION: In ESRD patients with hypertension associated due to increased volume overload, left ventricular hypertrophy secondary to hypertension and decreased renal clearance of NP resulted in an increase of plasma BNP levels. The serum NT-proBNP levels of the ESRD patients receiving peritoneal dialysis were detected significantly higher than the control group. This result is in line with previous studies, supporting the increase in serum BNP level in dialysis patients with chronic renal failure. CHF is a disease with high morbidity and mortality in ESRD patients. Considering that correlated with the prevalence of hypertensive retinopathy, it is understood that the importance of the fundoscopic examination in early stages in this patient group, for determining the degree of end-organ damage and HT. Also as a non-invasive method; measurement of serum BNP level will gain a new perspective on the evaluation of cardiorenal disease and the clinical diagnosis for more detailed studies on the diagnostic value of the opinion that will provide useful information, as our opinion.