Stage-Specific NT-proBNP Cutoffs Improve Detection of Heart Dysfunction in CKD Patients: Study
Türkiye: A study published in BMC Nephrology has highlighted the importance of using stage-specific thresholds when interpreting N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels to detect reduced left ventricular ejection fraction (LVEF) in patients with chronic kidney disease (CKD). The findings suggest that relying on a single universal cut-off may compromise diagnostic accuracy, particularly as kidney function declines.
The research, led by Davut Eren from the Nephrology Department at Kayseri City Hospital, Türkiye, examined the diagnostic utility of NT-proBNP for identifying systolic dysfunction—defined as LVEF below 50%—in patients with CKD Stages 3 to 5. Interpreting NT-proBNP in this population is complex because impaired renal clearance can elevate peptide levels independently of cardiac function. Additionally, cardiovascular comorbidities are common in CKD, further complicating clinical assessment.
This retrospective analysis included 840 patients with CKD. Participants were divided into two groups based on echocardiographic findings: 114 patients with reduced ejection fraction (REF) and 726 patients with preserved ejection fraction (PEF). The investigators used receiver operating characteristic (ROC) curve analysis to assess diagnostic performance and applied Youden’s J statistic to determine the most appropriate cut-off values for each CKD stage. Multivariate logistic regression was conducted to evaluate whether NT-proBNP independently predicted reduced LVEF after accounting for confounding factors.
The researchers reported the following findings:
- NT-proBNP levels were significantly higher in patients with reduced LVEF compared to those with preserved function.
- Median NT-proBNP concentrations were 2,962 pg/mL in the reduced ejection fraction group versus 437 pg/mL in the preserved group.
- In the overall cohort, NT-proBNP showed good diagnostic performance with an AUC of 0.805.
- An optimal overall cut-off value of 1,562 pg/mL yielded 71.3% sensitivity and 77.8% specificity for detecting systolic dysfunction.
- Diagnostic accuracy varied by CKD stage, with the highest performance in Stage 3a (AUC 0.872).
- Accuracy declined with worsening kidney function, reaching the lowest level in Stage 5 (AUC 0.647).
- Optimal NT-proBNP cut-off values increased progressively with advancing CKD: 694 pg/mL in Stage 3a, 1,452 pg/mL in Stage 3b, 1,562 pg/mL in Stage 4, and 2,121 pg/mL in Stage 5.
- After adjusting for atrial fibrillation and valvular heart disease, log-transformed NT-proBNP remained an independent predictor of reduced LVEF (odds ratio 2.37).
The authors concluded that NT-proBNP remains a valuable biomarker for identifying systolic dysfunction in patients with CKD, but interpretation should be tailored to the degree of renal impairment. Implementing stage-specific cut-off values may enhance diagnostic precision, particularly in early-to-moderate CKD, and could support timely referral for echocardiographic evaluation and appropriate cardiac management.
Reference:
Eren, D., Demir, M., Kuzu, Z. et al. The diagnostic value of N-terminal pro-B-type natriuretic peptide for low left ventricular ejection fraction by chronic kidney disease stage. BMC Nephrol (2026). https://doi.org/10.1186/s12882-026-04829-w
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