Natriuretic Peptides, Kidney Function, and Clinical Outcomes in Heart Failure With Preserved Ejection Fraction (JACC Heart Failure January 2025)-Article: Natriuretic Peptides, Kidney Function, and Clinical Outcomes in Heart Failure With Preserved Ejection Fraction

Article: Natriuretic Peptides, Kidney Function, and Clinical Outcomes in Heart Failure With Preserved Ejection Fraction

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This research investigates the role of N-terminal pro–B-type natriuretic peptides (NT-proBNP) in determining cardiovascular outcomes in heart failure patients with preserved ejection fraction and varying kidney functions. NT-proBNP is a guideline-recommended biomarker for heart failure risk assessment, but its prognostic value can be compromised by elevated levels in chronic kidney disease (CKD).<br /><br />Utilizing data from 14,831 participants in four clinical trials— I-PRESERVE, TOPCAT, PARAGON, and DELIVER—the study examines associations between NT-proBNP, estimated glomerular filtration rate (eGFR), and clinical outcomes. Participants were stratified by kidney function, measured using eGFR, and followed up for a median period of 33.5 months.<br /><br />Findings indicate that NT-proBNP levels rise as kidney function declines, but the relationship is nonlinear, with a pronounced increase in patients with significantly reduced kidney function (eGFR <45 mL/min/1.73 m²). Each doubling of NT-proBNP increased the risk of heart failure hospitalization or cardiovascular death by 37%, showing consistent risk across different kidney function categories.<br /><br />Absolute risk for adverse outcomes was notably higher for patients with decreased kidney function for a given NT-proBNP level, challenging the idea of adjusting NT-proBNP reference values upwards for patients with CKD. This suggests that reduced kidney function should not lead to dismissing elevated NT-proBNP measurements, as they hold important prognostic information.<br /><br />The research supports the continued use of NT-proBNP in heart failure prognostics across all levels of kidney function and cautions against modifying its reference values based solely on CKD presence. This would ensure valuable prognostic information in heart failure patients is not overlooked. The study also highlights potential implications for clinical trial designs and diagnostic strategies in populations possessing this dichotomy.

Keywords

NT-proBNP

heart failure

kidney function

eGFR

chronic kidney disease

cardiovascular outcomes

biomarker

prognostic value

clinical trials

risk assessment