NT-proBNP Levels: A Powerful Predictor of Cardiovascular and Renal Outcomes in CKD Patients with Anemia

A recent study published in European Society of Cardiology Heart Failure Journal suggests that elevated levels of N-terminal pro-brain natriuretic peptides (NT-proBNP) are linked to increased risk of cardiovascular and renal events in patients with advanced chronic kidney disease (CKD) experiencing anemia.

Led by Hiroshi Nishi, PhD, from the University of Tokyo Graduate School of Medicine, the research team conducted a post-hoc analysis of the BRIGHTEN trial, a large prospective observational clinical trial examining patients with non-dialysis kidney disease who had anemia. The analysis focused on the association between baseline NT-proBNP levels and various cardiovascular outcomes, such as cardiac death, acute coronary syndrome, hospitalization due to heart failure, fatal arrhythmia, and renal outcomes, including initiation of maintenance dialysis, kidney transplantation, and significant declines in estimated glomerular filtration rate (eGFR).

The study included 1484 patients, with a median NT-proBNP level of 496.0 pg/mL. During an average follow-up period of 2.29 years, researchers observed a nonlinear relationship between NT-proBNP levels and both cardiovascular and renal outcomes. Patients with baseline NT-proBNP levels ≥ 1000 pg/mL had significantly higher risks for cardiovascular events and renal events compared to patients with lower levels. Furthermore, higher NT-proBNP levels were associated with a faster decline in eGFR.

“Blood NT-proBNP level appears to be a valuable prognostic indicator for cardiovascular and renal outcomes in patients with advanced CKD experiencing anemia,” concluded the researchers. “For patients with high blood levels of NT-proBNP, daily management that takes into account the status of cardiovascular and renal risks is essential.”

The researchers emphasized the need for future studies to investigate the potential of utilizing NT-proBNP levels as a guiding factor in heart failure treatment to mitigate cardiovascular and renal outcomes in anemic patients with CKD.

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References

1. ^{Nishi H, Nangaku M, Sofue T, Kagimura T, Narita I. N-terminal pro-brain natriuretic peptide and cardiorenal outcome in patients with anaemia in chronic kidney disease. ESC Heart Fail. 2024 Dec 18. doi: 10.1002/ehf2.15042. Epub ahead of print. PMID: 39696837.}
2. ^{Tsutamoto T, Sakai H, Yamamoto T, Nakagawa Y. Renal Clearance of N-Terminal pro-Brain Natriuretic Peptide Is Markedly Decreased in Chronic Kidney Disease. Circ Rep. 2019 Aug 1;1(8):326-332. doi: 10.1253/circrep.CR-19-0063. PMID: 33693158; PMCID: PMC7892492.}
3. ^{Desai AS, Bibbins-Domingo K, Shlipak MG, Wu AH, Ali S, Whooley MA. Association between anaemia and N-terminal pro-B-type natriuretic peptide (NT-proBNP): findings from the Heart and Soul Study. Eur J Heart Fail. 2007 Sep;9(9):886-91. doi: 10.1016/j.ejheart.2007.06.005. Epub 2007 Jul 12. PMID: 17627881.}