Kidney Week

Abstract: TH-PO0316

Diagnostic Utility of N-Terminal Pro-B Type Natriuretic Peptide (NT-proBNP) for Tracking Cardiovascular Structural and Functional Alterations in Advanced CKD and After Kidney Transplantation

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

• Campos, Monique Opuszcka, Indiana University School of Medicine, Indianapolis, Indiana, United States

Monique Opuszcka Campos, PhD

• Narayanan, Gayatri, Indiana University School of Medicine, Indianapolis, Indiana, United States

Gayatri Narayanan, MS

• Groninger, Nolan, Indiana University School of Medicine, Indianapolis, Indiana, United States

Nolan Groninger, MPH

• Burney, Heather, Indiana University School of Medicine, Indianapolis, Indiana, United States

Heather Burney, MS

• Li, Xiaochun, Indiana University School of Medicine, Indianapolis, Indiana, United States

Xiaochun Li, PhD

• Zehnder, Daniel, North Cumbria Integrated Care NHS Foundation Trust, Whitehaven, England, United Kingdom

Daniel Zehnder, MD, PhD

• Hiemstra, Thomas, University of Cambridge, Cambridge, England, United Kingdom

Thomas Hiemstra, MD, PhD

• Lim, Kenneth, Indiana University School of Medicine, Indianapolis, Indiana, United States

Kenneth Lim, MD, PhD, FASN

Background

NT-proBNP is a highly sensitive biomarker used in the diagnosis and management of heart failure. However, its diagnostic value for the assessment of impaired cardiovascular functional capacity (CVC) in advanced CKD or after kidney transplantation (KT) is largely unknown. This study investigated the association between NT-proBNP and CVC (as assessed by VO₂Max) and cardiac structure in advanced CKD and post-KT.

Methods

We conducted a secondary analysis of 159 stage 5 CKD patients from the Cardiopulmonary Exercise Testing in Renal Failure and After Kidney Transplantation (CAPER) Cohort, including kidney transplant recipients (KTR) and waitlisted controls (NTWC). All participants underwent cardiopulmonary exercise testing (CPET) and echocardiography at baseline and one-year follow-up. A total of n=69 KTR patients underwent KT. Participants were stratified into baseline NT-proBNP quartiles: Q1 (<50 pg/ml, n=39), Q2 (50-170 pg/ml, n=40), Q3 (170.1-450 pg/ml, n=40), and Q4 (>451 pg/ml, n=40).

Results

Groups were well-matched by gender and race (P>0.05). Patients in Q4 had the lowest BMI, were older, had lower GFR, and were largely on hemodialysis (all P<0.03). Higher NT-proBNP groups had reduced VO₂Max (Q4:17.7 ± 4.6 vs Q1:21.8 ± 5.1 mL/min/kg), lower peak heart rate (HR), workload, endurance time (ET), and higher left ventricular mass index (LVMI) (all P<0.001). In KTRs, VO₂Max (+1.4 mL/min/kg), workload (+16.6 W), and endurance time (+0.7 min) improved at 12 months post-KT, alongside a 92% NT-proBNP reduction (all, P<0.001). NTWC showed declines in CVC measures and a rise in NT-proBNP (+89%,all P<0.001) at 12 months. Higher baseline logNT-proBNP in KTRs was negatively associated with longitudinal VO₂Max (β:-1.3 ± 0.4,P=0.004), peak HR (β:-8.1 ± 1.5), and workload (β:-9.9 ± 3.8), and positively correlated with LVMI (β:11.4 ± 2.4, all P<0.02). logNT-proBNP decline post-transplant was linked to improvements in VO₂Max, workload, and ET over 12 months (P<0.05).

Conclusion

Higher baseline NT-proBNP in advanced CKD patients is accompanied by poorer CVC and structural indices and is linked with worse CVC measures one-year post-KT. Our findings underscore NT-proBNP's potential value as a biomarker for CVC in pre- and post-transplant phases.

Funding

• Private Foundation Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025rzfk2jfj