Abstract: TH-PO0305
Heart Failure Phenotypes and the Prognostic Utility of N-Terminal Pro-B Type Natriuretic Peptide (NT-proBNP) in CKD: A Matched Cohort Study
Session Information
- Hypertension and CVD: Clinical - 1
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Lin, Yen Chung, Taipei Medical University Hospital, Taipei City, Taiwan
- Chen, Chien-Chou, Tri-Service General Hospital Department of Medicine, Taipei City, Taiwan
- Zheng, Cai-Mei, Taipei Medical University Shuang Ho Hospital Ministry of Health and Welfare, New Taipei, Taiwan
Background
Chronic kidney disease (CKD) frequently coexists with heart failure (HF), contributing significantly to patient morbidity and mortality. The two principal HF phenotypes, heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), exhibit distinct clinical trajectories and prognoses. Although NT-proBNP is a crucial biomarker for HF, its interpretation in CKD patients remains challenging due to impaired renal clearance, and its prognostic significance across different HF phenotypes in CKD has not been thoroughly investigated.
Methods
Using data from the TriNetX platform (2002–2020), we conducted a propensity score–matched cohort study of dialysis-independent CKD stage 3–5 patients diagnosed with either HFrEF or HFpEF. A total of 7,379 matched pairs were included. NT-proBNP levels were classified as high (≥2584.1 pg/mL) or low (<2584.1 pg/mL). Cox proportional hazards models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for major adverse cardiovascular events (MACE), major adverse kidney events (MAKE), and all-cause mortality over a 3-year follow-up period. Subgroup analyses were performed to assess outcome variation across clinical strata.
Results
After matching, baseline characteristics were balanced, with a mean age of 71 years and similar eGFR across groups. The proportion of patients with elevated NT-proBNP (≥2584.1 pg/mL) was also comparable between CKD-HFrEF and CKD-HFpEF groups. Compared to CKD-HFpEF, CKD-HFrEF was associated with significantly increased risks of MACE (39.80% vs. 35.34%; HR: 1.17, 95% CI: 1.09–1.26, p<0.001) and all-cause mortality (27.98% vs. 26.07%; HR: 1.09, 95% CI: 1.01–1.16, p=0.020). The higher NT-proBNP levels were independently predictive of higher MACE and mortality risks only in CKD-HFrEF patients.
Conclusion
In CKD patients, HFrEF and NT-proBNP category were associated with higher risks of MACE and mortality but not MAKE. NT-proBNP may aid in cardiovascular risk stratification, though its value for renal outcomes is limited.