Despite being an established biomarker for heart failure, the utility of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in identifying broader complications, such as cardiorenal dysfunction, has remained underexplored.^1,2 This knowledge gap, particularly within Asian populations, has limited the ability of clinicians to stratify risk and intervene early in patients at the highest risk of adverse outcomes.¹ A retrospective cohort study utilizing the Hong Kong Diabetes Biobank (HKDB), led by researchers from the Department of Medicine and Therapeutics, The Chinese University of Hong Kong (CUHK) found NT-proBNP as a reliable biomarker for predicting cardiovascular and renal complications in patients with type 2 diabetes (T2DM).¹

NT-proBNP is a peptide secreted by ventricular cells when the heart is under stress.1,3 While its role in diagnosing and managing heart failure is well-documented, its potential as a prognostic tool for predicting other cardiovascular and renal complications has not been fully realized.1-3 Recognizing the need to address this gap, Professor Ma, Ching-Wan Ronald from the Department of Medicine and Therapeutics at CUHK led a study to evaluate NT-proBNP’s predictive value for risk stratification and cardiorenal events in Chinese individuals with type 2 diabetes.¹

This multicenter cohort study leveraged data from the HKDB, which included 1,993 individuals with T2DM.¹ Using Cox regression analysis, the researchers examined the association between elevated NT-proBNP and incident cardiovascular and renal endpoints, adjusting for sex, age, diabetes duration, and other covariates.¹ The prognostic and incremental predictive value of NT-proBNP for cardiorenal complications in diabetes was compared with the Joint Asia Diabetes Evaluation risk equations for coronary heart disease (CHD), congestive heart failure (CHF), and kidney failure using the concordance index.¹

Approximately one in four participants, or 24.7%, had elevated NT-proBNP levels (≥125pg/mL) at baseline.¹ These individuals were found to have a two- to fourfold higher prevalence of cardiorenal complications compared to those with normal NT-proBNP levels.¹ Elevated NT-proBNP was also associated with a significantly increased risk of developing cardiovascular conditions, such as atrial fibrillation (HR=4.64; 95% CI: 2.44-8.85), CHD (HR=4.21; 95% CI: 2.46-7.21), cardiovascular disease (HR=3.32; 95% CI: 2.20-5.01), and CHF (HR=4.18; 95% CI: 2.18-8.03), as well as renal complications, including chronic kidney disease (HR=2.51; 95% CI: 1.76-3.57), kidney failure (HR=5.99; 95% CI: 4.11-8.72), and a 40% decline in estimated glomerular filtration rate (eGFR) (HR=3.13; 95% CI: 2.53-3.87).¹

The study also demonstrated the strong predictive value of NT-proBNP for a range of complications.¹ The biomarker achieved a concordance index (C-index) of >0.8 for many endpoints, including CHD (0.83), atrial fibrillation (0.88), CHF (0.89), a 40% decline in eGFR (0.81), and kidney failure (0.88).¹ These findings underscore the biomarker’s utility in enhancing existing risk prediction models, offering a significant improvement in precision prognostics for cardiorenal complications.¹

The researchers highlighted the practical implications of incorporating NT-proBNP into routine clinical assessments.¹ By identifying patients at elevated risk, clinicians can initiate early interventions, potentially mitigating the progression of these severe complications.^1,4 This is particularly important given the availability of effective medications to reduce cardiorenal complications in individuals with diabetes.^4,5 Thus, recognizing at-risk patients early is critical for improving long-term outcomes.¹

In conclusion, this CUHK study reinforces the potential of NT-proBNP as a valuable tool in managing T2DM.^1-3 Its ability to predict both cardiovascular and renal complications expands its utility beyond heart failure, addressing a critical need for better risk stratification in this population.¹ While further validation in diverse cohorts is necessary, the findings offer a promising step toward more personalized and effective care for individuals with diabetes.¹