Fast Five Quiz: Chronic Kidney Disease and Heart Failure

Patrick Rossignol, MD


February 03, 2023

Clinical findings and routine diagnostic tests are not always sufficient to diagnose heart failure, and the diagnosis can be particularly challenging in patients with CKD. For example, when clinical findings are ambiguous, rapid measurement of B-type natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP) levels is recommended to help clinicians differentiate between cardiac and noncardiac causes of dyspnea. However, elevated natriuretic peptide levels are characteristic of advanced CKD, which may weaken their diagnostic utility in patients with heart failure. Although definitive cutoff points for BNP and/or NT-proBNP concentrations have not been established for diagnosing heart failure in patients with CKD, standard BNP cutoff thresholds appear to be effective in stages I-II CKD.

While chest radiography remains a recommended diagnostic method in patients presenting with acute dyspnea and can help to identify other potential causes of breathlessness, such as pulmonary disease, published values of sensitivity and specificity of the chest radiograph for detection of pulmonary edema range from 14% to 68% and 53% to 96%, respectively. Thus, the absence of radiographic signs of congestion does not rule out heart failure.

Learn more about detecting complications in CKD.


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