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Abstract
Background Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels are common in patients with chronic kidney disease (CKD), but uniform thresholds derived from the general population may not accurately predict heart failure (HF) risk across stages of kidney function. This study aimed to determine whether thresholds specific to kidney function categories improve HF risk prediction in CKD.
Methods This retrospective cohort study used data from the China Renal Data System, including 18 261 patients with CKD without prior HF. Kidney function-specific thresholds for NT-proBNP were established based on estimated glomerular filtration rate (eGFR) categories, and associations with HF risk were assessed using multivariable Cox proportional hazard models. The predictive value of these thresholds was compared with a uniform threshold of 125 pg/mL using Net Reclassification Improvement (NRI).
Results Elevated NT-proBNP was observed in 67% of patients using the uniform threshold compared with 23% when using eGFR-specific thresholds. Optimal NT-proBNP thresholds increased with declining kidney function, reaching the highest level in stage 5 CKD (eGFR <15 mL/min/1.73 m²). eGFR-specific thresholds significantly improved HF risk prediction, with NRI gains of 19% to 55% across stages 1 to 5, while the uniform threshold added no predictive value for patients with stage 5 CKD.
Conclusions In patients with CKD, NT-proBNP levels must be interpreted in the context of kidney function, as eGFR-specific thresholds provide superior HF risk stratification. These findings support adopting kidney function-adjusted thresholds rather than a uniform cut-off to improve HF risk prediction.
- Cohort Studies
- Heart Failure
- Risk Assessment
Data availability statement
Data are available upon reasonable request.
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Data availability statement
Data are available upon reasonable request.
Footnotes
YL, JC and RC contributed equally.
Contributors YL designed the study, collected and analysed the data, and drafted the manuscript. JC contributed to the data analysis and critically revised the manuscript for important intellectual content. RC was involved in the analysis of the study and the interpretation of data. AFL improved the writing of the manuscript. SZ and YL provided administrative, technical and material support. SN and YT supervised the study and contributed to the critical revision of the manuscript. All authors read and approved the final manuscript. Guarantor: YT accepts full responsibility for the finished work and/or the conduct of the study, had access to the data and controlled the decision to publish.
Funding National Natural Science Foundation of China (Award Number: 82470711, 82070709 and 82100723); China Heart House-Chinese Cardiovascular Association HX fund (2022-CCA-HX-071); Guangzhou Science and Technology Project (2023A04J2457); President Foundation of The Third Affiliated Hospital of Southern Medical University (Award Number: YQ2021006, YQ202205 and YQ202207); Guangdong Basic and Applied Basic Research Foundation (Award Number: 2022A1515012356); The National Key R&D Program of China (Award Number: 2021YFC2500200 and 2021YFC2500204); The Key Technologies R&D Program of Guangdong Province (Award Number: 2023B1111030004).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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