N-TERMINAL PRO-B-TYPE NATRIURETIC PEPTIDE (NT-PROBNP) AND PROGRESSION OF CHRONIC KIDNEY DISEASE IN INDIAN CHRONIC KIDNEY DISEASE COHORT

Introduction:

It has been shown that elevated N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels are associated with the progression of kidney disease and may serve as a prognostic marker. This study aims to determine the association between baseline levels of NT-proBNP with renal and cardiovascular outcomes in CKD patients in the Indian Chronic Kidney Disease (ICKD) Study.

Methods:

The study encompassed 783 individuals diagnosed with mild to moderate CKD, enrolled in ICKD study, followed up for mean duration of 4.89 years. Levels of NT-ProBNP was analysed using commercially available ELISA kit (Elabscience, Texas, USA). Unadjusted and adjusted Cox proportional hazard models were used to study the association of time to occurrence of events: Major adverse kidney events (MAKE), end stage kidney disease (ESRD), ≥50% decline in eGFR, all-cause mortality, and cardiovascular (CVD) mortality. In assessing CVD mortality as a primary focus, deaths resulting from renal causes were considered as competing events. Similarly, when examining 50% eGFR decline, ESRD, and MAKE as key outcomes, non-renal deaths were treated as competing events.

Results:

In the study cohort, mean age of patients was 48.14 (12.18) years, 35.25% were women and mean eGFR (mL/min/1.73m2) at baseline was 45.88 (17.56).  249 (31.80%) developed MAKE and 197 (25.16%) progressed to ESKD. Overall mortality and CVD mortality was reported in 89 (11.37%) and 21 (2.68%) respectively. Median (IQR) level of NT-proBNP at the baseline was 4.65 (1.63, 16.36) ng/ml. Levels of NT-proBNP as per outcome is shown in figure 1. Similar association was found for unadjusted and adjusted Cox proportional hazard models suggesting that increase in the levels of NT-proBNP is associated with higher risk of MAKE (1.16; 1.01-1.34) and ESKD (1.19; 1.01-1.41) (Table 1). However, no significant association was found between the levels of NT-proBNP with respect to death and 50% eGFR decline (Table 1).

Conclusions:

Baseline levels of NT-proBNP was associated with higher risk of MAKE and ESRD. No significant association was found between the levels of NT-proBNP with respect to death and 50% eGFR decline. This study establishes the evidence that higher levels of NT-proBNP at baseline is a risk factor for CKD progression.  

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.