ArticleBMC nephrology2026
The diagnostic value of N-terminal pro-B-type natriuretic peptide for low left ventricular ejection fraction by chronic kidney disease stage.
Article in BMC nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundInterpreting 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.
methodsThis 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.
resultsMedian 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.
conclusionsNT-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.
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