Abstract: Objective To explore the diagnostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and soluble growth stimulation expressed gene 2(sST2)for heart failure(HF) in the elderly patients with chronic kidney disease(CKD). Methods A total of 269 hospitalized patients with CKD from 2018 to 2021 were enrolled and divided into 4 groups according to CKD stages by chronic kidney disease epidemiology collaboration (CKD-EPI) formula: CKD 1 stage, CKD 2 stage, CKD 3 stage, CKD 4-5 stage. The levels of serum NT-proBNP and sST2, renal function indexes and cardiac function indexes in the patients with different CKD stages were compared, and the correlations between serum NT-proBNP and sST2 level with estimated glomerular filtration rate (eGFR) were analyzed.The ROC curve was used to assess the value of serum sST2 and NT-proBNP in the diagnosis of HF in the elderly patients with CKD. Results Among all participants, the levels of serum NT-proBNP(r=-0.546, P<0.001) and sST2 (r=-0.204, P=0.001) were negatively correlated with eGFR. The cut-off value of NT-proBNP for the diagnosis of HF in CKD patients rose with the increase of renal function stage, respectively: CKD 1 stage: 407 pg/mL, CKD 2 stage: 1211.5 pg/mL, CKD 3 stage: 3482 pg/mL, CKD 4-5 stage: 6512 pg/mL. In CKD 3 stage, the accuracy of the diagnosis of HF in CKD patients by NT-proBNP combined with sST2 was better than that by NT-proBNP alone. Conclusions The diagnostic cut-off value of NT-proBNP for HF in the patients with different stages of CKD increases with the deterioration of renal function, and the diagnostic threshold should be adjusted according to the eGFR. For the patients with moderate renal decline, the combination of NT-proBNP and sST2 can improve the diagnostic accuracy of HF.

Key words: N-terminal pro-B-type natriuretic peptide, soluble growth stimulation expressed gene 2, chronic kidney disease, heart failure