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With great interest we read the article by Srisawasdi et al.1 They found that the ratio between N-terminal (NT)-pro-B-natriuretic peptide (BNP) and BNP increases exponentially with the stage of renal disease. van Kimmenade et al,2 however, suggested the NT-proBNP/BNP ratio increases only slightly and shows a linear trend. Their findings are used to support the hypothesis that BNP and NT-proBNP concentrations rely equally on the glomerular filtration rate and predominantly on cardiac diseases, rather than on renal clearance.2,3 The findings by Srisawasdi et al1 suggest otherwise, and they rightly advocate that renal dysfunction should be taken into account when interpreting the diagnostic and prognostic potential of NT-proBNP and BNP.Missing in the data from Srisawasdi et al1 are the ratios in the patients with end-stage renal disease who were treated with hemodialysis. On reading the article by Srisawasdi et al,1 we decided to take a look at the NT-proBNP/BNP ratios in a population of patients receiving long-term hemodialysis for whom we recently described cardiac biomarker concentrations4 and their relationship …

Renal Dysfunction, Hemodialysis, and the NT-proBNP/BNP RatioThe Authors’ Reply