What does an Elevated N-terminal Pro-brain Natriuretic Peptide (NT-pro-BNP) Mean in my Renal Patient?

The N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is released in response to volume expansion and/or increased tension on cardiac ventricular myocytes. In non-uremic patients, NT-pro-BNP is a useful diagnostic and prognostic biomarker for diagnosis and risk assessment of patients with heart failure. However, impaired kidney function is associated with elevated circulating levels of NT-proBNP. The present review summarizes the literature on NT-pro-BNP in kidney disease, both acute and chronic. We attempt to highlight the importance of estimating kidney function before interpreting an elevated NT-pro-BNP measurement. We also suggest that NT-pro-BNP is not a reliable marker of heart failure in the acute setting, but that longitudinal changes may be of value when tracking volume status in this patient group.