Impact of glomerular filtration rate on urinary BNP and NT-proBNP levels in heart failure

B-type natriuretic peptide (BNP) and its inactive amino-terminal fragment (NT-proBNP) are diagnostic tools for heart failure (HF), but less is understood regarding the effects of renal function on their urinary concentrations. The objective was to analyze the influence of renal function, as estimated glomerular filtration rate (eGFR), on BNP and NT-proBNP concentrations in 90 HF outpatients (65 ± 12 years; 73% men), grouped according to eGFR below or above 60 mL/min. Patients with worse eGFR had higher serum NT-proBNP (p < 0.01) and BNP (p < 0.01) than patients with higher eGFR: NT-proBNP, but urinary levels did not reach statistical differences. In addition, a direct significant correlation between filtered load of serum NT-proBNP or BNP with their concentrations in urine was found in patients with eGFR above 60 mL/min (r = 0.66, p < 0.001 and r = 0.338, p < 0.05) and below 60 mL/min (r = 0.63, p < 0.001 and r = 0.406, p < 0.01). However, after normalizing urinary natriuretic peptide concentrations by their filtered load, we obtained a significant inverse and exponential relation in patients with worse renal function for NT-proBNP and BNP (r = −0.87, p = 0.001; and r = −0.71, p < 0.001, respectively) and in patients with eGFR > 60 mL/min (r = −0.84, p < 0.001; and r = −0.72, p < 0.001, respectively). In conclusion, similar urinary NT-proBNP and BNP excretion was obtained in patients with high or low eGFR. Furthermore, despite the direct correlation between filtered load of serum natriuretic peptides with their urinary levels, an inverse an exponential relationship was obtained after normalizing urinary concentrations. Therefore, glomerular filtration does not seem to be the major determinant of both urinary peptide concentrations.

► Urinary excretion of NT-proBNP and BNP was similar, irrespective of eGFR.
► An inverse an exponential relationship was obtained between filtered load of natriuretic peptides with their urinary levels after normalizing urinary concentrations.
► Glomerular filtration alone does not seem to be the major determinant of the urinary concentration of natriuretic peptides
► Altered tubular handling could be involved in urinary natriuretic peptides clearance in our outpatients diagnosed with HF.