1317-P: The Use of NT-proBNP for Risk Stratification of Incident Cardiorenal Complications in Type 2 Diabetes—The Hong Kong Diabetes Biobank

NT-proBNP has emerged as a potential biomarker for cardiovascular complications. We examined the association between NT-proBNP with prevalent and incident diabetes complications, and compared it against prediction based on established risk equations. NT-proBNP was measured using an electrochemiluminescent immunoassay on a Roche cobas e411 analyzer in a subset of baseline samples from the Hong Kong Diabetes Biobank, a multi-centre prospective cohort of individuals with diabetes. All subjects underwent comprehensive assessment for diabetes complications, and were prospectively followed up. Among 1983 subjects with type 2 diabetes (60% male), mean age at recruitment was 61.1±11 years. At baseline, 24.7% of participants had NT-proBNP ≥125pg/ml. Those with NT-proBNP ≥125pg/ml had significantly higher SBP, lower eGFR, and a higher proportion had CHD, PVD and CHF at baseline (all p<0.001). In multivariate logistic regression adjusting for baseline age, sex, DM duration, smoking, BMI, waist, SBP, DBP, HbA1c, lipid traits, lnACR, eGFR and use of DM medications, NT-proBNP was associated with CVD and CKD at baseline. During median follow-up of 5.2 (5.0-5.4) years, baseline NT-proBNP (≥125 vs <125) was associated with increased risk of incident CVD with HR (95%CI) 2.34 (1.41, 3.89), CHF HR 2.60 (1.26, 5.37) and renal complications HR 1.88 (1.20, 2.96)(p <0.01). The cut-off of 125pg/ml showed good performance in differentiating between those with or without incident complications with C-index (95%CI) 0.82 (0.74, 0.89) for CHD, 0.87 (0.80, 0.94) for hospitalization with CHF and 0.86 (0.82, 0.90) for ESRD. Incorporating NT-proBNP improved prediction of CHD, CHF or ESRD compared to using the JADE risk equations alone. Our study highlights the utility of NT-proBNP for risk stratification of cardio-renal complications in T2DM.