Heart Failure Phenotypes and the Prognostic Utility of NT-proBNP in Patients With Chronic Kidney Disease

OBJECTIVE: To evaluate the prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) across different heart failure phenotypes in patients with chronic kidney disease (CKD). METHODS: This retrospective cohort study used data from the TriNetX Global Research Network to identify adults with non-dialysis-dependent CKD and concurrent heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF) between January 1, 2002, and December 31, 2020. Propensity score matching was applied to balance baseline characteristics. NT-proBNP and metabolic markers were analyzed, and outcomes were evaluated over a 3-year period, including all-cause mortality, major adverse cardiac events (MACE), and major adverse kidney events. RESULTS: Among 14,758 matched patients (n=7379 per group), those with HFrEF had significantly higher NT-proBNP levels and an elevated risk of all-cause mortality (HR, 1.09; P=.02) and MACE (HR, 1.17; P