ABSTRACT
Natriuretic peptide levels are elevated in persons with chronic kidney disease (CKD) stages 1-3, but it remains unclear whether this is associated with extracellular volume excess or early cardiovascular changes. We hypothesized that patients with CKD stages 1-3 would have evidence of cardiovascular changes, which would associate with brain natriuretic peptide (BNP), amino-terminal-pro-BNP (NT-pro-BNP), and patient-reported symptoms.Outpatients with CKD stages 1-3 and non-CKD controls were enrolled. Cardiovascular parameters included extracellular water (ECW) normalized to body weight measured using whole-body multifrequency bioimpedance spectroscopy, and total peripheral resistance index (TPRI) and cardiac index measured by impedance cardiography. Dyspnea, fatigue, depression, and quality of life were quantified using questionnaires.Among 21 participants (13 with CKD), median (IQR) BNP was 47.0 (28.0-302.5) vs 19.0 (12.3-92.3) pg/mL, p=0.07, and NT-pro-BNP was 245.0 (52.0-976.8) vs 26.0 (14.5-225.8) pg/mL, p=0.08, in the CKD and control groups, respectively. Those with CKD had higher pulse pressure (79 (66-87) vs 64 (49-67) mm Hg, p=0.046) and TPRI (3721 (3283-4278) vs 2933 (2745-3198) dyn×s/cm5/m2, p=0.01) and lower cardiac index (2.28 (2.08-2.78) vs 3.08 (2.43-3.37) L/min/m2, p=0.02). In the overall cohort, natriuretic peptides correlated with pulse pressure (BNP r=0.59; NT-pro-BNP r=0.58), cardiac index (BNP r=-0.76; NT-pro-BNP r=-0.62), and TPRI (BNP r=0.48), p<0.05 for each, but not with ECW/weight. TPRI and blood pressure correlated moderately with symptoms.Elevated natriuretic peptides may coincide with low cardiac index and elevated peripheral resistance in patients with CKD stages 1-3. The role of these biomarkers to detect subclinical cardiovascular changes needs to be further explored.
ABSTRACT
Background: Women Veterans using Veterans Affairs (VA) maternity care represent a high-risk population owing to the high prevalence of psychiatric disorders, such as depression, anxiety, and posttraumatic stress disorder (PTSD). Given the increased risk of symptom recurrence and/or medication discontinuation during pregnancy, the aim of this study was to understand the relationship between mental health and health care utilization in pregnant Veterans within the Veterans Health Administration (VHA). Materials and Methods: Women with a confirmed pregnancy were recruited from 15 VA sites across the United States. Data sources included diagnosis codes, clinic stop codes for outpatient visits, and 30-day antidepressant prescriptions in the electronic health record. Results: Overall, mental health visits increased slightly from prepregnancy to pregnancy before decreasing in the postpartum period. For women with a prepregnancy diagnosis of depression, anxiety, and/or PTSD, there was an increase in psychotherapy utilization during the pregnancy and postpartum periods, whereas the percentage of women utilizing antidepressants only or antidepressants plus therapy decreased during these same time periods. A small proportion of women with histories of mental health conditions did not utilize mental health care within the VA during pregnancy and postpartum. Conclusions: These results inform our understanding of VA health care utilization patterns in pregnant Veterans, particularly those with a history of depression, PTSD, and/or anxiety. The strong utilization of VA mental health services during this time emphasizes the importance of optimizing the coordination of care between VA mental health providers and community-provided obstetric care to enhance outcomes for both mother and child.
