In a massive European study, three cardiac peptide biomarkers — NT-proBNP, MR-proANP, and MR-proADM — were strongly associated with kidney function decline and chronic kidney disease, with the highest NT-proBNP levels linked to 5.7-fold higher CKD odds.
5.72× higher CKD oddsPeople with the highest NT-proBNP levels (a heart stress peptide) had nearly six times the odds of having chronic kidney disease compared to those with the lowest levels
What the researchers found
In cross-sectional analysis of up to 61,830 participants, all three cardiac peptide markers — MR-proADM, MR-proANP, and NT-proBNP — were consistently associated with lower kidney function (eGFR) and higher CKD prevalence. Per 1 standard deviation increase in log-transformed NT-proBNP (corresponding to a 2.71-fold concentration increase), eGFR was 2.35 ml/min/1.73m² lower. Participants in the highest NT-proBNP group had 5.72-fold higher odds of CKD compared to the lowest group.
In longitudinal analysis of 4,205 individuals, higher baseline NT-proBNP predicted faster eGFR decline: -1.37 ml/min/1.73m² per 1 SD increase over 10 years, and higher CKD incidence. Associations were stronger in participants with existing cardiovascular disease and diabetes, suggesting the heart-kidney peptide connection is especially important in these high-risk populations.
Why it matters
Chronic kidney disease is often called a 'silent disease' because kidney function can decline significantly before symptoms appear. Finding that routinely measured heart peptides can predict kidney decline means clinicians could identify at-risk patients earlier using tests they may already be ordering. This is especially valuable for patients with heart disease or diabetes, who are at high risk for both cardiac and kidney complications.
How the study worked
This was a large observational study within the BiomarCaRE project, a European multi-cohort collaboration. Cross-sectional analyses included up to 61,830 participants with measurements of MR-proADM, MR-proANP, and NT-proBNP. Longitudinal analysis followed 4,205 individuals with NT-proBNP data over approximately 10 years. Kidney function was assessed using eGFR calculated from creatinine, cystatin C, or both. Markers were categorized into four groups for dose-response analysis. Models were adjusted for cardiovascular risk factors.
What this study cannot tell us
The longitudinal analysis was limited to NT-proBNP only and included a smaller subset (4,205 of 61,830). As an observational study, it cannot prove that elevated cardiac peptides cause kidney decline — both may reflect shared risk factors. Different cohorts within BiomarCaRE used different eGFR equations and collection methods. The study did not test whether interventions that lower natriuretic peptide levels also protect kidney function.
How to read the evidence
This is a large, well-powered observational study with both cross-sectional (n=61,830) and longitudinal (n=4,205) components from a major European multi-cohort project. While observational design limits causal inference, the large sample size and consistent results across three biomarkers and multiple eGFR methods provide strong evidence.
When this study was published
Published in 2026, this is a very current study leveraging the large BiomarCaRE European dataset. It represents the latest evidence on cardiac peptide biomarkers as predictors of kidney disease.
The bigger picture
Natriuretic peptides like BNP and ANP are among the most clinically important peptide biomarkers in medicine, primarily used for heart failure diagnosis. This study reveals their additional utility as kidney disease predictors, reflecting the fundamental biological connection between cardiac stress and renal function. The cardiorenal syndrome — where heart and kidney failure reinforce each other — is a major clinical challenge. Using cardiac peptides as dual biomarkers could enable more integrated management of both organ systems.
Questions still open
- Should routine NT-proBNP testing in cardiac patients be used to screen for early kidney disease risk?
- Would treatments that reduce cardiac stress (and lower natriuretic peptide levels) also slow kidney function decline?
- Could MR-proADM or MR-proANP add predictive value beyond NT-proBNP for kidney disease screening?
Common questions
What are natriuretic peptides and why does the heart release them?
If my NT-proBNP is high, does that mean my kidneys are at risk?
Read the original research
Longitudinal and cross-sectional associations of myocardial stress markers with kidney function and chronic kidney disease in the BiomarCaRE project.
Scientific reports, 16(1)
Citation
Lin, Jie-Sheng; Zeller, Tanja; Koenig, Wolfgang; Jousilahti, Pekka; Kee, Frank; Iacoviello, Licia; Tunstall-Pedoe, Hugh; Söderberg, Stefan; Cesana, Giancarlo; Palmieri, Luigi; Salomaa, Veikko; de Man Lapidoth, Julia; De Ponti, Roberto; Donfrancesco, Chiara; Lorenz, Thiess; Kuulasmaa, Kari; Blankenberg, Stefan; Peters, Annette; Thorand, Barbara. (2026). Longitudinal and cross-sectional associations of myocardial stress markers with kidney function and chronic kidney disease in the BiomarCaRE project.. Scientific reports, 16(1). https://doi.org/10.1038/s41598-026-37377-2