NT-proBNP levels in nephropathy cases with and without diabetes, echocardiographic abnormality, and hypertension

Öz

Objective: Increased NT-proBNP level is a diagnostic sign for heart failure and is associated with cardiovascular mortality. It is related to chronic kidney disease (CKD) in also cases without heart failure. In this study, the authors aimed to investigate NT-proBNP levels in CKD cases with and without diabetes, echocardiographic abnormality, and hypertension. Methods: Sixty-four cases (26 diabetic and 38 non-diabetic) with stage 3-4 CKD were investigated in the study. Blood pressure values were measured on the right arm after resting for at least 5 minutes. M-mode two-dimensional echocardiography device and ultrasonography were used to evaluate cardiac and renal findings. Blood samples were taken for biochemical, hematological, hormonal and serological parameters of the patients after 12 hours of fasting. Nt-proBNP levels were measured by Elecys ProBNP sandwich immunoassay method in the Biochemistry laboratory. Results: NT-proBNP levels were not statistically different according to the presence and absence of diabetes (p=0.821) in CKD cases. However, stage-4 CKD had significantly higher NT-proBNP level than stage-3 CKD in both diabetic (p<0.001) and non-diabetic cases (p<0.001). NT-proBNP levels showed similarity in cases with and without echocardiographic abnormality in both diabetics (p=0.135) and non-diabetics (p=0.531). Similarly, CKD cases with and without hypertension were not different in NT-proBNP levels in both diabetics (p=0.412) and non-diabetics (p=0.432). Conclusion: The present findings suggest that NT-proBNP level is related to the severity of CKD rather than the presence of diabetes and cardiovascular disorders.

Anahtar Kelimeler

• NT-proBNP
• kidney disease
• diabetes mellitus
• echocardiography

Kaynakça

1. 1.Yang P, Rooney MR, Wallace AS, et al. Associationsbetween diet quality and NT-proBNP in U.S. adults,NHANES 1999-2004. Am J Prev Cardiol 2023; 16:100528.
2. 2.Lu Y, Chen J, Su L, et al. N-terminal pro-B-typenatriuretic peptide, eGFR, and progression of kidney disease in chronic kidney disease patients without heart failure. Clin Kidney J 2024; 17: sfae298.
3. 3.Tsutamoto T, Sakai H, Yamamoto T, Nakagawa Y.Renal Clearance of N-Terminal pro-Brain Natriuretic Peptide Is Markedly Decreased in Chronic KidneyDisease. Circ Rep 2019; 1: 326-32.
4. 4.Khan MS, Januzzi JL Jr, Liu Y, et al. NatriureticPeptides and Prognosis in Patients With Type 2Diabetes Mellitus and High Risk for CardiovascularEvents. J Card Fail 2024: 30: 1544-51.
5. 5.Zhao Y, Zhao L, Wang Y, et al. The association ofplasma NT-proBNP level and progression of diabetic kidney disease. Ren Fail 2023; 45: 2158102.
6. 6.Sawada R, Hashimoto Y, Senmaru T, et al. SerumN-terminal Pro-brain Natriuretic Peptide Level isAssociated with the Development of Chronic KidneyDiseases in Patients with Type 2 Diabetes. EndocrMetab Immune Disord Drug Targets 2018; 18: 590-5.
7. 7. Roointan A, Shafieizadegan S, Ghaeidamini M, et al.The potential of cardiac biomarkers, NT-ProBNPand troponin T, in predicting the progression ofnephropathy in diabetic patients: A meta-analysis ofprospective cohort studies. Diabetes Res Clin Pract2023; 204: 110900.
8. 8.Teramoto K, Tay WT, Tromp J, et al. LongitudinalNT-proBNP: Associations With EchocardiographicChanges and Outcomes in Heart Failure. J Am HeartAssoc 2024; 13: e032254.

9. 9.Neuen BL, Vaduganathan M, Claggett BL, et al.Natriuretic Peptides, Kidney Function, and ClinicalOutcomes in Heart Failure With Preserved EjectionFraction. JACC Heart Fail 2025: 13: 28-39.
10. 10.Rørth R, Jhund PS, Yilmaz MB, et al. Comparisonof BNP and NT-proBNP in Patients With HeartFailure and Reduced Ejection Fraction. Circ Heart Fail 2020; 13: e006541.
11. 11.Lee JE, Choi SY, Huh W, et al. N-terminal pro-brain natriuretic peptide levels predict leftventricular systolic function in patients with chronickidney disease. J Korean Med Sci. 2009; 24Suppl(Suppl 1): S63-8.
12. 12.Mishra RK, Li Y, Ricardo AC, et al. Chronic RenalInsufficiency Cohort Investigators. Association of N-terminal pro-B-type natriuretic peptide with leftventricular structure and function in chronic kidneydisease (from the Chronic Renal InsufficiencyCohort [CRIC]). Am J Cardiol. 2013; 111(3): 432-8.
13. 13.David S, Kümpers P, Seidler V, et al. Diagnosticvalue of N-terminal pro-B-type natriuretic peptide(NT-proBNP) for left ventricular dysfunction inpatients with chronic kidney disease stage 5 onhaemodialysis. Nephrol Dial Transplant 2008; 23:1370-7.
14. 14.Löfman I, Szummer K, Dahlström U, Jernberg T,Lund LH. Associations with and prognostic impact of chronic kidney disease in heart failure withpreserved, mid-range, and reduced ejection fraction.Eur J Heart Fail 2017; 19: 1606-14.
15. 15.Voordes GHD, Voors AA, Hoegl A, et al. Clinicaland proteomic profiles of chronic kidney disease inheart failure with reduced and preserved ejectionfraction. Int J Cardiol 2024; 417: 132580.
16. 16.Curtis KA, Waikar SS, Mc Causland FR. HigherNT-proBNP levels and the risk of intradialytichypotension at hemodialysis initiation. Hemodial Int 2024; 28: 77-84.
17. 17.Claudel SE, Waikar SS, Gopal DM, Verma A.Association of cardiac biomarkers, kidney function,and mortality among adults with chronic kidneydisease. medRxiv [Preprint] 2023:2023.12.12.23299886.