[Clinical relevance of the determination of plasma atrial natriuretic peptide in children with chronic renal failure].

To investigate whether plasma atrial natriuretic peptide (ANP) is a valuable index to detect fluid expansion in children with endstage renal disease, we studied 34 children and adolescents on regular intermittent hemodialysis or on continuous ambulatory peritoneal dialysis (CAPD). In 22 pediatric patients, plasma ANP was markedly elevated prior to hemodialysis and fell to near normal levels after dialysis (109.9 +/- 80.0 to 39.0 +/- 23.1 fmol/ml, means +/- SD). During removal of fluid excess by 1-h sequential ultrafiltration without dialysis in eight adolescents, plasma ANP fell from 123.8 +/- 97.0 to 45.3 +/- 24.6 fmol/ml. Ultrafiltration was followed by 3 h hemodialysis with fluid removal and ANP decreased further to 29.6 +/- 12.1 fmol/ml. In 12 patients on CAPD, plasma ANP was similar to that in 96 healthy control children (29.3 +/- 28.9 vs 23.9 +/- 11.9 fmol/ml) and did not differ from that in 12 children with advanced chronic renal failure (32.6 +/- 20.1 fmol/ml) and seven successfully transplanted children (32.4 +/- 8.5 fmol/ml). Four patients on hemodialysis (post dialysis), one on patients on hemodialysis (post dialysis), one on CAPD and two with advanced chronic renal failure had definitely elevated ANP levels (greater than 56 fmol/ml = greater than 3 SD mean of controls) indicating fluid volume overload. It is concluded that plasma ANP is elevated in children with chronic renal failure due to volume expansion and that measurement of plasma ANP is a sensitive marker to detect fluid overload in these children.