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Natriuretic Peptides, Kidney Function, and Clinical Outcomes in Heart Failure With Preserved Ejection Fraction
Brendon L Neuen1, Muthiah Vaduganathan2, Brian L Claggett3
1Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; The George Institute for Global Health, University of New South Wales, Sydney, Australia; Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia.
JACC. Heart Failure
|October 4, 2024
Summary
N-terminal pro-B-type natriuretic peptides (NT-proBNP) predict higher adverse outcomes in heart failure patients with reduced kidney function. Higher NT-proBNP levels in chronic kidney disease (CKD) patients should not be disregarded.
Area of Science:
- Cardiology
- Nephrology
- Biomarker Research
Background:
- N-terminal pro-B-type natriuretic peptides (NT-proBNP) are key heart failure biomarkers.
- Elevated NT-proBNP in chronic kidney disease (CKD) complicates risk assessment across eGFR levels.
Purpose of the Study:
- To evaluate NT-proBNP's association with cardiovascular and mortality outcomes in heart failure patients.
- To stratify these associations by baseline kidney function (eGFR).
Main Methods:
- Pooled analysis of 14,831 participants from four major heart failure trials (I-PRESERVE, TOPCAT, PARAGON, DELIVER).
- Piecewise linear regression assessed NT-proBNP and eGFR relationship.
- Multivariable Cox and Poisson models evaluated NT-proBNP's association with outcomes across eGFR strata.
Main Results:
- NT-proBNP levels inversely correlated with eGFR, increasing significantly as eGFR decreased.
- Each doubling of NT-proBNP associated with a 37% increased risk of primary outcome (heart failure hospitalization or CV death), consistent across eGFR categories.
- For equivalent primary outcome incidence, NT-proBNP levels were 2.5-3.5 fold lower in patients with eGFR <45 mL/min/1.73 m² compared to eGFR ≥60 mL/min/1.73 m².
Conclusions:
- A given NT-proBNP concentration indicates a substantially higher absolute risk of adverse outcomes in heart failure patients with reduced kidney function.
- Findings challenge proposed higher NT-proBNP reference ranges for CKD patients.
- Reduced kidney function should not be a reason to ignore elevated NT-proBNP levels in heart failure.
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