Kidney Week

Abstract: SA-PO360

N-terminal Pro B-Type Natriuretic Peptide (NT-proBNP) and Cardiovascular Structure and Function in Advanced CKD

Session Information

• Hypertension, CVD, and the Kidneys: Clinical Research
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Campos, Monique Opuszcka, Indiana University School of Medicine, Indianapolis, Indiana, United States

Monique Opuszcka Campos, PhD

• Voors, William, Indiana University School of Medicine, Indianapolis, Indiana, United States

William Voors, MD

• Hiemstra, Thomas, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom

Thomas Hiemstra, MD, PhD

• Narayanan, Gayatri, Indiana University School of Medicine, Indianapolis, Indiana, United States

Gayatri Narayanan, MS

• Lim, Kenneth, Indiana University School of Medicine, Indianapolis, Indiana, United States

Kenneth Lim, MD, PhD, FASN

Background

NT-proBNP is a clinically used diagnostic marker in managing of heart failure. Unfortunately, interpretation of NT-proBNP levels is complicated in patients with CKD as the peptide is renally cleared. Furthermore, few studies, if any have assessed the diagnostic value of NT-proBNP in evaluating impaired cardiovascular functional (CVF) –a major complication in advanced CKD. Herein, we investigated the role of NT-proBNP levels in regulating CV structure and function in patients with advanced CKD.

Methods

We conducted a cross-sectional study of baseline data from 242 participants from the Cardiopulmonary Exercise Testing in Renal Failure and After Kidney Transplantation (CAPER) Cohort: advanced CKD stage 5 and 5D patients on the transplant list (n=159) and hypertension patients (n=83). All patients underwent cardiopulmonary exercise testing (CPET) to assess CVF capacity (VO₂Peak) and echocardiography. Participants were stratified into quartiles per NT-proBNP levels. One-way ANOVA was used for group comparisons and associations assessed using Pearson’s Correlation.

Results

NT-proBNP levels across quartiles were: <8.1pg/ml (n=59), 8.2-43pg/ml (n=61), 43.1-262pg/ml (n=61), and >262.1pg/ml (n=61). Age did not significantly differ between the groups (p>0.05). However, patients in the lowest NT-proBNP quartile had higher BMI values (Q1:28.3±3.8 kg/m²; p<0.0001). Patients with highest quartile had lower GFR (Q4:7.0[5,8] ml/min per 1.73 m², median [IQR]). Significantly, patients with higher NT-proBNP had reduced VO₂Peak (Q1:26.4±7.5; Q4:18.4±4.7 mL/min/kg;p<0.0001). Additionally, those in the higher NT-proBNP strata exhibited greater left ventricular mass index (LVMI) (Q1:87.7±18.1; Q4:129.4±40.1 g/m²), lower heart rate (HR) at peak exercise (Q1:157±18; Q4:123±24 bpm), and ejection fraction (Q1:66 ±5;Q4: 60±10%), p<0.0001 for all. NT-proBNP levels were negatively associated with VO₂Peak (r=-0.18;p=0.006), HR (r=-0.27;p=0.0001), ejection fraction (r=-0.22;p=0.0004), and GFR (r=-0.77;p<0.0001) and a positive correlation with LVMI (r=0.44;p<0.0001).

Conclusion

Higher NT-proBNP levels were associated with impaired CV structure and function in patients with advanced CKD. The study suggests that NT-proBNP is a potential biomarker for assessing CVF impairment in advanced CKD.

Funding

• Private Foundation Support