Optimizing NT-proBNP and Left Ventricular Filling Pressure for Accurate Diagnosis of Acute Decompensated Heart Failure in Chronic Kidney Disease Patients

Abstract

Objectives: Diagnosing Acute Decompensated Heart Failure (ADHF) in patients with Chronic Kidney Disease (CKD) is challenging due to the complexities in interpreting N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. This study aimed to determine an optimal NT-proBNP cutoff value in CKD patients with ADHF confirmed by elevated left ventricular filling pressure (LVFP).

Methodology: In this retrospective, cross-sectional study conducted at Doctors Hospital, Lahore, between May 1, 2018, and April 30, 2019, 85 hospitalized patients were evaluated, of which 66 had CKD. All participants presented with clinical evidence of volume overload. NT-proBNP levels and estimated glomerular filtration rate (eGFR) were assessed, while LVFP was measured to confirm the diagnosis of ADHF.

Results: Median NT-proBNP levels were significantly higher in the CKD patients with elevated LVFP compared to those with normal LVFP (12,186 pg/mL vs. 2,528 pg/mL, p < 0.003). The NT-proBNP cutoff for CKD patients with clinical volume overload was determined to be 1,750 pg/mL. For all patients with high LVFP (including both CKD and non-CKD), the cutoff was 2,760 pg/mL. However, in CKD patients with clinical volume overload confirmed by high LVFP, the optimal NT-proBNP cutoff value was 3,737 pg/mL.

Conclusion: Elevated NT-proBNP levels correlate with CKD and high LVFP. Utilizing a higher NT-proBNP cutoff value improves diagnostic accuracy for ADHF in CKD patients, aiding in more reliable clinical decision-making.