Prognostic Value of Natriuretic Peptide Levels for Adverse Renal Outcomes in Patients With Moderate to Severe Acute Kidney Injury With or Without Heart Failure

Abstract

Background Natriuretic peptides have been recommended as biomarkers for the diagnosis and prognosis of patients with heart failure and are often elevated in the setting of acute kidney injury. We sought to demonstrate the associations between increased baseline NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) and adverse renal outcomes in patients with moderate‐to‐severe acute kidney injury. Methods and Results We reviewed electronic medical records of consecutive patients with acute kidney injury stage 2 and 3 admitted to the Cleveland Clinic between September 2011 and December 2021. Patients with NT‐proBNP levels collected before renal consultation or dialysis initiation were included. Adverse renal outcomes included dialysis requirement and dialysis dependence defined as patients undergoing dialysis within 72 hours before hospital discharge or in‐hospital mortality. In our study cohort (n=3811), 2521 (66%) patients underwent dialysis, 1619 (42%) patients became dialysis dependent, and 1325 (35%) patients had in‐hospital mortality. After adjusting for cardiorenal risk factors, compared with the lowest quartile, the highest quartile of NT‐proBNP (≥18 215 pg/mL) was associated with increased likelihood of dialysis requirement (adjusted odds ratio [OR], 2.36 [95% CI, 1.87–2.99]), dialysis dependence (adjusted OR, 1.89 [95% CI, 2.53–1.34]), and in‐hospital mortality (adjusted OR, 1.34 [95% CI, 1.01–1.34]). Conclusions Increased NT‐proBNP was associated with an increased risk of dialysis requirement, becoming dialysis dependent, and in‐hospital mortality in patients with moderate‐to‐severe acute kidney injury.