Association between N-terminal Pro-Brain Natriuretic Peptide levels, glomerular filtration rate, and heart failure in the Multi-Ethnic Study of Atherosclerosis

BACKGROUND: This study examined the complementary prognostic role of NT-proBNP and eGFR for predicting heart failure (HF) in adults with and without chronic kidney disease (CKD) defined as eGFR<60 ml/min/1.73m2. METHODS: We used data from the Multi-Ethnic Study of Atherosclerosis, a cohort of 6814 adults without baseline clinical cardiovascular disease. Five-year risk prediction of HF based on clinical HF risk variables (HFRV) plus NT-proBNP, eGFR or both was assessed using the C-statistic and the net reclassification index (NRI) after stratifying by CKD status. RESULTS: Mean age at baseline was 62.3±10.3 years and CKD were present in 5.9%. A total of 39 and 180 HF events occurred in participants with and without CKD, respectively. Among adults with CKD, the C-statistic for HF risk prediction increased significantly (P =0.04) from 0.71 (95% CI 0.64, 0.78) with HFRV alone to 0.78 (95% CI 0.71, 0.85) with addition of NT-proBNP. In the non-CKD group, the C-statistic increased from 0.77 (95% CI 0.74, 0.80) with HFRV alone to 0.83 (95% CI 0.80, 0.85) with addition of NT-proBNP. Further addition of eGFR to the model did not alter the C-statistic regardless of CKD status. NRI improved by 23.1% and 10.2% in CKD and non-CKD, respectively, with the addition of NT-proBNP alone and findings were similar when both eGFR and NT-proBNP were both added to model. CONCLUSIONS: In adults without clinical cardiovascular disease, the addition of NT-proBNP but not eGFR to established HFRV improves HF risk prediction in adults with and without CKD.