RESEARCH ARTICLE NT-proBNP Linking Low-Moderately Impaired Renal Function and Cardiovascular Mortality in Diabetic Patients: The Population-Based Casale Monferrato Study

Background: Few data are available to assess whether a low-moderate reduction in estimated glomerular filtration rates (eGFR) has a role per se on cardiovascular (CV) mortality or other biomarkers such as NT-proBNP allow to explain such association. Methods and Findings: In a prospective study including 1,645 type 2 diabetic subjects of the population-based Casale Monferrato Study, who had no clinical evidence of heart failure and eGFR.45 ml/min/1.73 m2, we examined 6 years CV mortality. Multivariate Cox proportional hazards modeling were used to estimate the effect of NT-proBNP on the association between eGFR and mortality, independently of baseline CV risk factors, albumin excretion rate (AER) and C-reactive protein (CRP). During follow-up, 327 people died (149 of CV diseases) out of 8334.5 person-years. Compared to eGFR$90 ml/min/1.73 m2, values of 60–89 and 45–59 ml/min/ 1.73 m2 conferred a fully adjusted hazard ratios (HRs) of CV mortality of 1.74 (1.08– 2.82) and 1.95 (1.03–3.68), respectively. After further adjustment for NT-proBNP