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HFpEF Diagnosis: A Challenge in CKD with Current Algorithms.

Anca E Stefan1,2, Maria A Covic1,3, Gianina Dodi1

  • 1Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania.

Life (Basel, Switzerland)
|June 26, 2026
PubMed
Summary

Diagnosing heart failure with preserved ejection fraction (HFpEF) in chronic kidney disease (CKD) patients is complex. NT-proBNP levels vary, necessitating CKD-specific diagnostic strategies for accurate HFpEF assessment.

Keywords:
CKD HFpEFCKD HFpEF metabolic riskHFpEF CKDcardio-kidney-metabolic axischronic kidney disease heart failure

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Area of Science:

  • Cardiology
  • Nephrology
  • Biomarkers

Background:

  • Chronic kidney disease (CKD) significantly increases cardiovascular remodeling and heart failure with preserved ejection fraction (HFpEF) risk.
  • Diagnosing HFpEF in CKD is challenging due to coexisting structural cardiac abnormalities and elevated NT-proBNP levels.

Purpose of the Study:

  • To evaluate HFpEF classification in ambulatory CKD patients using a modified HFA-PEFF approach.
  • To assess the impact of NT-proBNP thresholds on HFpEF diagnosis in CKD.
  • To explore NT-proBNP's relationship with diastolic dysfunction and cardiac structure in CKD.

Main Methods:

  • Cross-sectional study of CKD stages G3-G4 patients with NYHA II dyspnea.
  • Comprehensive clinical, metabolic, vascular, and echocardiographic assessments.
  • Modified HFA-PEFF algorithm application for HFpEF assessment, including NT-proBNP threshold analysis.

Main Results:

  • High prevalence of cardiometabolic burden (74.9%) and structural cardiac abnormalities.
  • HFpEF identified in 52.9% using the modified algorithm; 86.7% fell into intermediate probability without biomarker domain.
  • A cohort-adapted NT-proBNP threshold of 700 pg/mL identified 19.8% of patients with HFpEF.

Conclusions:

  • CKD G3-G4 patients show significant cardiovascular abnormalities, often undiagnosed.
  • HFpEF classification is sensitive to NT-proBNP thresholds, indicating limited discriminatory power for diastolic dysfunction.
  • Development of CKD-sensitive HFpEF diagnostic approaches is crucial for this population.