Diagnostic Value of NT-proBNP and Left Ventricular Filling Pressure in Chronic Kidney Disease (CKD) Patients with Acute Decompensated Heart Failure

BackgroundThe diagnosis of Acute Decompensated Heart Failure (ADHF) in Chronic Kidney Disease(CKD) patients is complex, NT-pro BNP interpretation in such a setting is complicated. The aim of this study is to determine the cutoff for NT-proBNP in CKD patients with ADHF. Methods: In this retrospective, cross-sectional study, 85 hospitalized patients were evaluated, 66 had CKD. All patients had clinical evidence of volume overload. NT-proBNP and eGFR were assessed in all patients. Left Ventricular Filling Pressure (LVFP) was measured to confirm the diagnosis of ADHF. Results: NT-proBNP was higher in volume overloaded patients with age more than 75 years as compared to those less than 75 years. NT-proBNP was higher in patients with CKD compared to non CKD patients. NT-proBNP progressively increased according to the CKD stage. The cutoff of NT- proBNP in patients with clinical evidence of volume overload and CKD was 1750 pg/ml and 2760 pg/ml in patients with high LVFP. In CKD patients with clinical volume overload and a high LVFP the NT-proBNP cutoff value was 3737pg/ml. There was a positive correlation of NT-BNP with LVFP and diastolic dysfunction. Conclusion: NT-proBNP has utility for the diagnosis of ADHF. It is higher in the CKD population and rises progressively with CKD stages. The cutoff for the diagnosis of ADHF in CKD patients is 3737 pg/ml in the setting of confirmed evidence of ADHF with a high LVFP.