N-terminal pro-B-type natriuretic peptide, eGFR and progression of kidney disease in chronic kidney disease patients without heart failure

Abstract

Abstract Background Cardiorenal syndrome highlights the bidirectional relationship between kidney and heart dysfunction. N-terminal pro-B-type natriuretic peptide (NT-proBNP), which is the gold standard biomarker in heart failure (HF), may be an important biomarker for chronic kidney disease (CKD) progression. However, NT-proBNP is negatively related with estimated glomerular filtration rate (eGFR). In this study, we investigated the association of NT-proBNP, eGFR and progression of kidney disease in CKD patients without HF. Methods This multicentric retrospective cohort study recruited 23 860 CKD patients without HF, who had at least one NT-proBNP record from China Renal Data System database. Linear regression model evaluated the relationship between eGFR and NT-proBNP. Cox regression analysis assessed the association between NT-proBNP and CKD progression. Sensitivity analysis examined the robustness of the main findings. Results This study involved 23 860 CKD patients without heart failure, distributed across different CKD stages: 10 526 in stages G1-2, 4 665 in G3a, 3 702 in G3b, 2 704 in G4, and 2 263 in G5. NT-proBNP was negatively correlated with eGFR, particularly in stages 4–5 CKD. A 15-unit decrease in eGFR was associated with increases in log (NT-proBNP) levels by 1.04-fold, 1.27-fold, 1.29-fold, 1.80-fold, and 3.50-fold for stages 1–2, 3a, 3b, 4, and 5, respectively. After excluding patients who developed CKD progression within one year, the Cox regression analysis revealed that the relationship between NT-proBNP and CKD progression was not significant in stages 4 and 5. However, for stages 1–3, each standard deviation increase in log (NT-proBNP) was associated with a 26%, 36%, and 28% higher risk of CKD progression, with P-interaction ≤ 0.001. The hazard ratios were 1.26 (95% CI, 1.18 to 1.35), 1.36 (95% CI, 1.22 to 1.51), and 1.28 (95% CI, 1.14 to 1.43) for stages 1–2, stage 3a, and stage 3b, respectively. Conclusions Despite its strong inverse association with eGFR, NT-proBNP was positively associated with the risk of progression of kidney disease in CKD patients with stages 1–3 without HF. Future studies should investigate the effectiveness of NT-proBNP as a predictive biomarker for the progression of kidney disease across diverse racial groups and healthcare settings.