Abstract: TH-PO1060
Association of N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) with the Progression of CKD in Indian CKD Cohort
Session Information
- CKD Progression and Complications: Diagnosis, Prognosis, Risk Factors
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Yadav, Ashok Kumar, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
- Kundu, Monica, The George Institute for Global Health India, New Delhi, Delhi, India
- Ghosh, Arpita, The George Institute for Global Health India, New Delhi, Delhi, India
- Kumar, Vivek, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
- Jha, Vivekanand, The George Institute for Global Health India, New Delhi, Delhi, India
Group or Team Name
- Indian Chronic Kidney Disease Study Group.
Background
It has been shown that elevated 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. 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 years, 35% were women and the mean eGFR at baseline was 46 mL/min/1.73m2. 249 (32%) developed MAKE and 197 (25%) progressed to ESKD. Median (IQR) level of NT-proBNP at the baseline was 4.65 (1.63, 16.36) ng/ml. 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.
Conclusion
This study establishes the evidence that higher levels of NT-proBNP at baseline is a risk factor for CKD progression.
Association of NT-proBNP with Outcomes CKD subjects
| Model 1 Sub-hazard ratio (95%CI) | Model 2 Sub-hazard ratio (95%CI) | Model 3 Sub-hazard ratio (95%CI) | |
| Major adverse kidney events (MAKE) | 1.16 (1.02, 1.32) P = 0.02 | 1.17 (1.03, 1.33) P = 0.02 | 1.16 (1.01, 1.34) P = 0.04 |
| 50% eGFR decline | 1.15 (0.99, 1.35) P = 0.07 | 1.16 (0.99, 1.35) P = 0.06 | 1.14 (0.97, 1.35) P = 0.11 |
| End stage kidney disease (ESKD) | 1.18 (1.02, 1.37) P = 0.03 | 1.19 (1.03, 1.38) P = 0.02 | 1.19 (1.01, 1.41) P = 0.04 |
| All-cause mortality* | 1.11 (0.89, 1.38) P = 0.37 | 1.09 (0.88, 1.36) P = 0.43 | 1.09 (0.86, 1.38) P = 0.47 |
| CVD mortality | 1.20 (0.84, 1.73) P = 0.32 | 1.19 (0.83, 1.73) P = 0.35 | 1.15 (0.77, 1.72) P = 0.48 |
Model 1 was unadjusted. Model 2 was adjusted for age and gender. Model 3 was adjusted for variables in model 2 + systolic BP, tobacco consumption status, estimated glomerular filtration and urine albumin-to-creatinine ratio. *Hazard ratio is reported.
Funding
- Government Support – Non-U.S.