Changes in Natriuretic Peptide Levels and Subsequent Kidney Function Decline in SPRINT

Rationale & Objective: Novel approaches to the assessment of kidney disease risk during hypertension treatment are needed because of the uncertainty of how intensive blood pressure (BP) lowering impacts kidney outcomes. We determined whether longitudinal N-terminal pro–B-type natriuretic peptide (NT–proBNP) measurements during hypertension treatment are associated with kidney function decline. Study Design: Prospective observational study. Setting & Participants: 8,005 SPRINT (Systolic Blood Pressure Intervention Trial) participants with NT–proBNP measurements at baseline and 1 year. Exposure: 1-year change in NT–proBNP categorized as a ≥25% decrease, ≥25% increase, or <25% change (stable). Outcome: Annualized change in estimated glomerular filtration rate (eGFR) and ≥30% decrease in eGFR. Analytical Approach: Linear mixed-effect and logistic regression models were used to evaluate the association of changes in NT–proBNP with subsequent annualized change in eGFR and ≥30% decrease in eGFR, respectively. Analyses were stratified by baseline chronic kidney disease (CKD) status. Results: Compared with stable 1-year NT–proBNP levels, a ≥25% decrease in NT–proBNP was associated with a slower decrease in eGFR in participants with CKD (adjusted difference, 1.09%/y; 95% CI, 0.35-1.83) and without CKD (adjusted difference, 0.51%/y; 95% CI, 0.21-0.81; P = 0.4 for interaction). Meanwhile, a ≥25% increase in NT–proBNP in participants with CKD was associated with a faster decrease in eGFR (adjusted difference, −1.04%/y; 95% CI, −1.72 to −0.36) and risk of a ≥30% decrease in eGFR (adjusted odds ratio, 1.44; 95% CI, 1.06-1.96); associations were stronger in participants with CKD than in participants without CKD (P = 0.01 and P < 0.001 for interaction, respectively). Relationships were similar irrespective of the randomized BP arm in SPRINT (P > 0.2 for interactions). Limitations: Persons with diabetes and proteinuria >1 g/d were excluded. Conclusions: Changes in NT–proBNP during BP treatment are independently associated with subsequent kidney function decline, particularly in people with CKD. Future studies should assess whether routine NT–proBNP measurements may be useful in monitoring kidney risk during hypertension treatment. Plain-Language Summary: N-terminal pro–B-type natriuretic peptide (NT–proBNP) is a biomarker in the blood that reflects mechanical stress on the heart. Measuring NT–proBNP may be helpful in assessing the risk of long-term losses of kidney function. In this study, we investigated the association of changes in NT–proBNP with subsequent kidney function among individuals with and without chronic kidney disease. We found that increases in NT–proBNP are associated with a faster rate of decline of kidney function, independent of baseline kidney measures. The associations were more pronounced in individuals with chronic kidney disease. Our results advance the notion of considering NT–proBNP as a dynamic tool for assessing kidney disease risk.