Session: MON 723-757-Renin-Angiotensin-Aldosterone System/Endocrine Hypertension
Bench to Bedside
Poster Board MON-739
Methods: Blood samples were collected from an unselected patient population at entry to the Emergency Department. If P-Na ≤ 125 mmol/L the plasma sample was frozen for further analyses. A comprehensive assessment of volume status, the underlying aetiology to their hyponatremia and treatment effect was made after patient discharge, and mid-regional pro-atrial natriuretic peptide (MR-proANP) levels were analyzed in the admission blood sample. Patient evaluation was performed blinded for ANP results.
Results: A total of 81 patients were included in the study and of these patients a well substantiated volemic state (hypo- eu- or hypervolemia) could be established in 72 patients (mean age 76 years, 65% women, median P-Na 119 mmo/L).
A significant association was observed between MR-proANP levels and volemic state in linear regression analysis (beta-coefficient 0.30 SD of MR-proANP per volemia class, 95% CI 0.15-0.44, p=0.0001). In a multivariate backward elimination model (entering age, gender, thiazide or loop diuretics, heart failure, cirrhosis, oedema, gastrointestinal losses and MR-proANP) MR-proANP remained significantly related to volemia state (beta-coefficient 0.18 SD of MR-proANP per volemia class, 95% CI 0.04-0.32, p=0.012).
As the distinction between mild hypovolemia and euvolemia is the clinically more predominant issue, data was also analyzed with respect to hypo- or euvolemia (n=59) using logistic regression. In a crude analysis, MR-proANP was significantly related to euvolemia (OR: 2.54 per SD of MR-proANP, 95% CI 1.32-4.86, p=0.005) and remained so after the multivariate backward elimination model (OR:2.45 per SD of MR-proANP, 95%CI 1.22-4.91, p=0.012.)
Conclusions: MR-proANP may be of value in early and objective determination of volume status in hyponatremic patients facilitating management and choice of treatment regimen.
Nothing to Disclose: KO, SE, B, OM
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