Kidney Week

Abstract: TH-PO899

Association of Longitudinal B-Type Natriuretic Peptide Monitoring With Kidney Replacement Therapy and Heart Failure in Patients With CKD

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - I
  November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2201 CKD (Non-Dialysis): Epidemiology‚ Risk Factors‚ and Prevention

Authors

• Oka, Tatsufumi, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, United States

Tatsufumi Oka,

• Sakaguchi, Yusuke, Department of Inter-Organ Communication Research in Kidney Diseases, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

Yusuke Sakaguchi,

• Hattori, Koki, Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

Koki Hattori,

• Asahina, Yuta, Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

Yuta Asahina,

• Kajimoto, Sachio, Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

Sachio Kajimoto,

• McCallum, Wendy I., Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, United States

Wendy I. McCallum,

• Tighiouart, Hocine, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, United States

Hocine Tighiouart,

• Sarnak, Mark J., Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, United States

Mark J. Sarnak,

• Kaimori, Jun-Ya, Department of Inter-Organ Communication Research in Kidney Diseases, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

Jun-Ya Kaimori,

• Isaka, Yoshitaka, Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

Yoshitaka Isaka,

Background

Existing evidence suggests that B-type natriuretic peptide (BNP) reflects volume status in patients with chronic kidney disease (CKD). Although longitudinal monitoring of BNP may result in optimal fluid management, including the avoidance of volume overload, potentially leading to better renal prognosis, its clinical benefit remains uncertain.

Methods

In this retrospective cohort study, adult CKD outpatients with stages 3–5 not on dialysis referred to an academic hospital between 2005 and 2018 were analyzed. The exposure variable was monitoring of plasma BNP. Study outcomes included kidney replacement therapy (KRT) and heart failure (HF) hospitalization. Applying marginal structural models using inverse probability of weighting (IPW), which created a balanced pseudo-population at each time point, the associations between longitudinal BNP monitoring and outcomes were examined. IPW-weighted pooled logistic regression models were employed to estimate the hazard ratios (HRs). Patient demographics, comorbidities, laboratory data, and medications were considered as potential time-dependent confounders.

Results

Among 2998 outpatients, median age and eGFR were 66 years and 38.4 mL/min/1.73 m², respectively. During follow-up (median, 5.9 years), 449 patients required KRT and 236 were hospitalized for HF. After adjustment for time-dependent confounders, longitudinal BNP monitoring was associated with lower risks of KRT (HR, 0.45; 95% confidence interval [CI], 0.21–0.93) and HF hospitalization (HR, 0.37; 95% CI, 0.15–0.94). The association between longitudinal BNP monitoring and KRT was attenuated after additional adjustment for HF hospitalization as a time-dependent covariate.

Conclusion

Among patients with CKD not on dialysis, longitudinal BNP monitoring was associated with a lower risk of requirement for KRT, potentially mediated by a reduced risk of HF hospitalization.