Chronic kidney disease (CKD) progression in diabetes is commonly assessed using urinary markers, yet additional biomarkers may improve risk stratification. A cohort study published in Diabetes Research and Clinical Practice evaluated the independent prognostic value of B-type natriuretic peptide (BNP) for CKD progression in adults with diabetes and evaluated its incremental value when combined with urinary albumin-to-creatinine ratio (UACR).

The analysis included 636 adults with diabetes who were followed for a median of 5.4 years. The primary endpoint was a ≥30% decline in estimated glomerular filtration rate (eGFR). Discrimination was assessed using time-dependent area under the curve (AUC) analyses, comparing the incremental value of BNP and urinary markers when added to a clinical base model.

During follow-up, 74 participants reached the primary endpoint. Baseline median BNP was 14.5 pg/mL, and baseline median UACR was 21 mg/g. BNP demonstrated prognostic performance comparable to UACR, protein-to-creatinine ratio (UPCR), and dipstick proteinuria. In adjusted analyses, BNP remained independently associated with CKD progression after accounting for UACR and other covariates (p = 0.002).

Spline analyses showed a graded association between BNP levels and risk of CKD progression, including within the normal BNP range (≤18.4 pg/mL), paralleling the risk gradient observed with UACR. Combined elevations of BNP and UACR identified individuals at the highest risk of kidney function decline.

These findings indicate that BNP was independently associated with kidney function decline and provided graded risk stratification beyond urinary markers in adults with diabetes.