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Background <p>Interpreting N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in chronic kidney disease (CKD) is challenging due to reduced renal clearance and frequent cardiovascular comorbidities. This study evaluated the diagnostic accuracy of NT-proBNP for identifying reduced left ventricular ejection fraction (LVEF &lt; 50%) across different CKD stages.</p> Methods <p>This retrospective study included 840 patients with CKD Stages 3–5. Patients were categorized into reduced ejection fraction (REF, LVEF &lt; 50%; <i>n</i> = 114) and preserved ejection fraction (PEF, LVEF ≥ 50%; <i>n</i> = 726) groups. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis, and stage-specific optimal cut-off values were determined by Youden’s J statistic. Multivariate logistic regression was used to identify independent predictors of reduced LVEF.</p> Results <p>Median NT-proBNP levels were significantly higher in the REF group than in the PEF group (2,962 vs. 437 pg/mL, <i>p</i> &lt; 0.001). In the overall cohort, NT-proBNP demonstrated good diagnostic performance (AUC: 0.805), with an optimal cut-off value of 1,562 pg/mL yielding 71.3% sensitivity and 77.8% specificity. Diagnostic accuracy differed according to renal function, being highest in Stage 3a (AUC: 0.872) and lowest in Stage 5 (AUC: 0.647). Optimal thresholds increased progressively with advancing CKD: 694 pg/mL (Stage 3a), 1,452 pg/mL (Stage 3b), 1,562 pg/mL (Stage 4), and 2,121 pg/mL (Stage 5). In multivariate analysis, log-transformed NT-proBNP remained an independent predictor of reduced LVEF (OR: 2.37, 95% CI: 1.96–2.86, <i>p</i> &lt; 0.001), after adjustment for potential confounders including atrial fibrillation and valvular heart disease.</p> Conclusions <p>NT-proBNP is a useful marker for detecting systolic dysfunction in patients with CKD. However, a single diagnostic threshold is inadequate; stage-specific cut-off values improve diagnostic precision, particularly in early-to-moderate CKD, and may facilitate earlier referral for echocardiographic evaluation.</p>

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The diagnostic value of N-terminal pro-B-type natriuretic peptide for low left ventricular ejection fraction by chronic kidney disease stage

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月20日

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  • Davut Eren,
  • Mustafa Demir,
  • Zülfiye Kuzu,
  • Sümeyra Koyuncu,
  • Vedat Gençer,
  • Tamer Arıkan,
  • Koray Uludağ

摘要

Background

Interpreting N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in chronic kidney disease (CKD) is challenging due to reduced renal clearance and frequent cardiovascular comorbidities. This study evaluated the diagnostic accuracy of NT-proBNP for identifying reduced left ventricular ejection fraction (LVEF < 50%) across different CKD stages.

Methods

This retrospective study included 840 patients with CKD Stages 3–5. Patients were categorized into reduced ejection fraction (REF, LVEF < 50%; n = 114) and preserved ejection fraction (PEF, LVEF ≥ 50%; n = 726) groups. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis, and stage-specific optimal cut-off values were determined by Youden’s J statistic. Multivariate logistic regression was used to identify independent predictors of reduced LVEF.

Results

Median NT-proBNP levels were significantly higher in the REF group than in the PEF group (2,962 vs. 437 pg/mL, p < 0.001). In the overall cohort, NT-proBNP demonstrated good diagnostic performance (AUC: 0.805), with an optimal cut-off value of 1,562 pg/mL yielding 71.3% sensitivity and 77.8% specificity. Diagnostic accuracy differed according to renal function, being highest in Stage 3a (AUC: 0.872) and lowest in Stage 5 (AUC: 0.647). Optimal thresholds increased progressively with advancing CKD: 694 pg/mL (Stage 3a), 1,452 pg/mL (Stage 3b), 1,562 pg/mL (Stage 4), and 2,121 pg/mL (Stage 5). In multivariate analysis, log-transformed NT-proBNP remained an independent predictor of reduced LVEF (OR: 2.37, 95% CI: 1.96–2.86, p < 0.001), after adjustment for potential confounders including atrial fibrillation and valvular heart disease.

Conclusions

NT-proBNP is a useful marker for detecting systolic dysfunction in patients with CKD. However, a single diagnostic threshold is inadequate; stage-specific cut-off values improve diagnostic precision, particularly in early-to-moderate CKD, and may facilitate earlier referral for echocardiographic evaluation.