Heart Failure Phenotypes and the Prognostic Utility of NT-proBNP in Patients With Chronic Kidney Disease: A Propensity-Score Matched Cohort Study.

OBJECTIVE

To evaluate the prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) across different heart failure phenotypes in patients with chronic kidney disease (CKD).

METHODS

This retrospective cohort study used data from the TriNetX Global Research Network to identify adults with non-dialysis-dependent CKD and concurrent heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF) between January 1, 2002, and December 31, 2020. Propensity score matching was applied to balance baseline characteristics. NT-proBNP and metabolic markers were analyzed, and outcomes were evaluated over a 3-year period, including all-cause mortality, major adverse cardiac events (MACE), and major adverse kidney events.

RESULTS

Among 14,758 matched patients (n=7379 per group), those with HFrEF had significantly higher NT-proBNP levels and an elevated risk of all-cause mortality (HR, 1.09; P=.02) and MACE (HR, 1.17; P<.001) compared with patients with HFpEF. Major adverse kidney events incidence did not differ significantly between groups. Elevated NT-proBNP was strongly associated with adverse cardiovascular outcomes in the HFrEF subgroup. Distinct metabolic and nutritional profiles also influenced outcome trajectories.

CONCLUSION

Among patients with CKD, those with HFrEF exhibited higher risks of MACE and mortality than those with HFpEF, especially in the presence of elevated NT-proBNP. Although NT-proBNP facilitates cardiovascular risk stratification, its predictive value for renal outcomes in patients with concurrent CKD and heart failure is limited.