High-normal levels of B-type natriuretic peptide are associated with chronic kidney disease progression independent of albuminuria in individuals with diabetes: an observational cohort study.

AIMS: To evaluate the independent prognostic value of B-type natriuretic peptide (BNP) for chronic kidney disease (CKD) progression in comparison with urinary albumin-to-creatinine ratio (UACR), protein-to-creatinine ratio (UPCR), and dipstick proteinuria, and assess its incremental value when added with UACR.

METHODS

We analyzed 636 adults with diabetes followed for median 5.4 years. The primary endpoint was a ≥30% estimated glomerular filtration rate (eGFR) decline. Discrimination was assessed using time-dependent area under the curve (AUC), comparing the incremental value of BNP and urinary markers added to a clinical base model.

RESULTS

During follow-up, 74 participants reached the endpoint. Baseline median BNP and UACR were 14.5 pg/mL and 21 mg/g, respectively. BNP showed prognostic performance (AUC) comparable to UACR, UPCR, and dipstick proteinuria. BNP was independently associated with CKD progression after adjustment for UACR and covariates (p = 0.002). Spline analyses demonstrated a graded risk even within the normal BNP range (≤18.4 pg/mL), paralleling the UACR risk gradient. Combined BNP and UACR elevations identified those at highest risk.

CONCLUSIONS

BNP is independently associated with kidney function decline, enabling graded risk stratification even within normal ranges. As a cardiac-derived marker of cardiorenal vulnerability, BNP complements urinary measures in identifying high-risk individuals with diabetes.