2026 Volume 59 Issue 1 Pages 7-16
Maintenance hemodialysis patients have a high prevalence of heart failure, and some exhibit latent cardiac dysfunction even when the left ventricular ejection fraction is preserved. Angiotensin receptor‒neprilysin inhibitors (ARNIs) are effective for heart failure but increase human atrial natriuretic peptide (hANP), making it difficult to distinguish pharmacologic effects from fluid overload when determining dry weight (DW). In contrast, N‒terminal pro‒B‒type natriuretic peptide (NT‒proBNP) is not influenced by ARNI therapy, and an increase of≥30％ is considered an indicator of worsening heart failure. In this study, we retrospectively analyzed 102 patients who received ARNI therapy and evaluated hANP, NT‒proBNP, blood pressure, cardiothoracic ratio (CTR), and DW at the baseline, 1 month, and 3 months after initiation. We examined the degree of hANP elevation that may still facilitate safe clinical observation. hANP increased from 77.9 to 156.0 pg/mL (p＜0.001) and 163.5 pg/mL (p＜0.001), approximately corresponding to a 2.2‒fold rise, whereas NT‒proBNP decreased, and no deterioration was observed in blood pressure, CTR, or DW. In patients with＜30％ NT‒proBNP elevation, hANP increased only 2.2‒fold at 1 month and 2.0‒fold at 3 months, being significantly lower than in those with≥30％ elevation. Multivariable analysis identified≥30％ NT‒proBNP elevation and diabetes mellitus as independent predictors of a greater hANP increase. These findings suggest that when hANP increases only to around twofold after ARNI initiation, the rise is likely attributable to pharmacologic effects, and careful follow‒up may be appropriate.
