The association of plasma NT-proBNP level and progression of diabetic kidney disease

Abstract

Aims

Diabetic kidney disease (DKD) is the most common cause of end-stage kidney disease (ESKD). The identification of risk factors involved in the progression of DKD to ESKD is expected to result in early detection and appropriate intervention and improve prognosis. This study aimed to explore whether plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) was associated with kidney outcomes in patients with type 2 diabetes mellitus (T2DM) and biopsy-proven DKD.

Methods

Patients with biopsy-proven DKD who were followed up at West China Hospital over 12 months were enrolled. The kidney outcome was defined as progression to ESKD. The cutoff value of plasma NT-proBNP concentration was calculated by using receiver operating characteristic (ROC) curve analysis. The influence of NT-proBNP levels on kidney outcome in patients with DKD was assessed using Cox regression analysis.

Results

A total of 30 (24.5%) patients reached ESKD during a median follow-up of 24.1 months. The baseline serum NT-proBNP level had a significant correlation with baseline proteinuria, kidney function, glomerular lesions, interstitial fibrosis tubular atrophy (IFTA), and arteriolar hyalinosis. Multivariate Cox regression analysis indicated that increased NT-proBNP level was significantly associated with a higher risk of progression to ESKD (HR 6.43; 95% CI (1.65–25.10, p = 0.007), and each 1 SD increase in LG (NT-proBNP) was also associated with a higher risk (HR 2.43; 95% CI 1.94–5.29, p = 0.047) of an adverse kidney outcome after adjusting for confounding factors.

Conclusions

A higher level of plasma NT-proBNP predicts kidney prognosis in patients with biopsy-proven DKD. This warrants further investigation into the potential mechanisms.

Keywords:

• NT-proBNP
• diabetic kidney disease
• type 2 diabetes mellitus
• end-stage kidney disease

Acknowledgements

An abstract of this article was previously submitted to the IDF Congress in August 2021 and published as an abstract in diabetes research and clinical practice in April 2022. Y. Zhao, IDF21-0263 The association of plasma NT-proBNP level and progression of diabetic nephropathy, Diabetes Research and Clinical Practice, Volume 186, Supplement 1, 2022, 109641, ISSN 0168-8227, https://doi.org/10.1016/j.diabres.2022.109641.

Ethics approval and consent to participate

The study protocol was approved by the Institutional Review Board at the West China Hospital of Sichuan University [number 2013R01], and written informed consent was obtained from all participants.

Consent for publication

All patients provided informed consent.

Authors’ contributions

Fang Liu, Nanwei Tong, and Lijun Zhao designed the experiments. Yuancheng Zhao, Lijun Zhao, Yiting Wang, Junlin Zhang, Rui Zhang, Honghong Ren, Yucheng Wu, and Yutong Zou collected the data. Yuancheng Zhao and Lijun Zhao wrote the main manuscript. Yuancheng Zhao prepared Tables (1–4) and Figures (1–2).

Disclosure statement

The authors have no conflicts of interest to disclose, and the results in this paper have not been published previously in whole or in part.

Consent for publication

All patients provided informed consent.

Data availability statement

The datasets generated during and analyzed during the current study are available from the corresponding author upon reasonable request.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China [Grant numbers 81970626 and 81670662] and the Key Research and Development Project of the Sichuan Science and Technology Department [Grant number 19ZDYF1273]. The authors thank Aimi Academic Services (www.aimieditor.com) for English language editing and review services.