Fujii Hideki, Goto Shunsuke
Division of Nephrology, Kobe University Graduate School of Medicine, Kobe, Japan.
Hypertens Res. 2025 Jul 1. doi: 10.1038/s41440-025-02272-2.
Both B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are clinically used for diagnosing and monitoring heart failure. However, their levels are influenced by several factors, and their impacts on chronic kidney disease (CKD) patients remain unclear. This study included 1036 patients who visited the Nephrology division at our hospital between 2014 and 2015. Plasma BNP, NT-proBNP levels and the BNP/NT-proBNP ratio were measured at each CKD stage, and their correlation with clinical factors were analyzed. This study included 1037 patients with stage 1 to stage 5D CKD (CKD 1-2, n = 114; CKD 3, n = 256; CKD 4, n = 266; CKD 5, n = 298; CKD 5D, n = 102). Levels of plasma BNP and NT-proBNP levels and the NT-proBNP/BNP ratio increased, and the correlation between BNP and NT-proBNP levels weakened with declining kidney function. Although various clinical factors were found to be significantly correlated with these parameters, multivariate analysis showed that male gender and hemoglobin, phosphate, and parathyroid hormone levels were significantly correlated with both plasma BNP and NT-proBNP levels. Notably, a higher NT-proBNP/BNP ratio was significantly associated with increased cardiovascular events in patients with CKD stages 4 and 5. As plasma BNP and NT-proBNP levels are influenced by various factors in patients with CKD, careful interpretation of these parameters is essential. In patients with advanced-stage CKD, the NT-proBNP/BNP ratio may be a useful predictor of CVD development.
B型利钠肽（BNP）和N末端B型利钠肽原（NT-proBNP）在临床上均用于诊断和监测心力衰竭。然而，它们的水平受多种因素影响，其对慢性肾脏病（CKD）患者的影响仍不明确。本研究纳入了2014年至2015年间在我院肾病科就诊的1036例患者。在每个CKD阶段测量血浆BNP、NT-proBNP水平以及BNP/NT-proBNP比值，并分析它们与临床因素的相关性。本研究纳入了1037例1至5D期CKD患者（CKD 1-2期，n = 114；CKD 3期，n = 256；CKD 4期，n = 266；CKD 5期，n = 298；CKD 5D期，n = 102）。随着肾功能下降，血浆BNP和NT-proBNP水平以及NT-proBNP/BNP比值升高，且BNP与NT-proBNP水平之间的相关性减弱。尽管发现多种临床因素与这些参数显著相关，但多因素分析显示男性性别以及血红蛋白、磷酸盐和甲状旁腺激素水平与血浆BNP和NT-proBNP水平均显著相关。值得注意的是，在CKD 4期和5期患者中，较高的NT-proBNP/BNP比值与心血管事件增加显著相关。由于CKD患者的血浆BNP和NT-proBNP水平受多种因素影响，因此对这些参数进行仔细解读至关重要。在晚期CKD患者中，NT-proBNP/BNP比值可能是心血管疾病发生的有用预测指标。
