Abstract
<title>Abstract</title> <p> <underline> <italic>Background</italic> </underline> <bold/> Acute kidney injury (AKI) is a serious complication in acute decompensated heart failure (ADHF). While N-terminal pro-brain natriuretic peptide (NT-proBNP) is a well-established biomarker for heart failure, its role in predicting AKI is less studied. This study investigated the association of plasma NT-proBNP levels and the risk of AKI and adverse renal outcomes in ADHF patients. <underline> <italic>Methods</italic> </underline> <bold/> This retrospective, single-centre, cohort study enrolled decompensated heart failure patients with measured plasma NT-proBNP levels from October, 2021 to September, 2022. The primary outcome was AKI during hospitalization per Kidney Disease Improving Global Outcomes (KDIGO) creatinine criteria. Secondary outcomes included AKI severity (defined by the maximal stage of AKI), renal recovery within 3 months, and hospitalization duration. <underline> <italic>Results</italic> </underline> <bold/> Of 669 patients studied, 289 (43%) developed AKI (stage 1: 53%, stage 2: 31%, stage 3: 16%). Multivariate analyses showed plasma NT-proBNP level was significantly associated with AKI risk (adjusted OR 1.470, [95% CI 1.347 to 1.604], p <0.001), more severe AKI stages (adjusted OR of stage 1 AKI, 1.344; stage 2, 1.631; stage 3, 1.878; all p <0.001) and prolonged hospitalization (adjusted IRR 1.087, p <0.001). The association persisted in CKD stages 1 to 3 (adjusted OR among CKD stage 1 to 2, 1.488, p <0.001; CKD stage 3, 1.376, p = 0.001). ROC analysis identified an NT-proBNP cut-off of 1450 pg/mL for AKI prediction (AUC 0.74, sensitivity 71.3%, specificity 65%). <underline> <italic>Conclusion</italic> </underline> <bold/> Elevated plasma NT-proBNP levels were independently associated with the risk of AKI and adverse renal outcomes in ADHF patients. These findings highlight the potential role of NT-proBNP in stratifying renal risk in heart failure patients. </p>