{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:01:53Z","timestamp":1780635713661,"version":"3.54.1"},"reference-count":19,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Chronic kidney disease (CKD) is associated with a high burden of cardiovascular remodeling and increased risk of heart failure with preserved ejection fraction (HFpEF). However, the interpretation of natriuretic peptide-based HFpEF diagnostic remains challenging in CKD populations, where structural cardiac abnormalities and elevated NT-proBNP levels frequently coexist. Methods: We conducted a cross-sectional study including ambulatory patients with CKD stages G3\u2013G4 and NYHA II dyspnea. Clinical, metabolic, vascular, and echocardiographic assessments were performed. HFpEF was assessed using a modified HFA-PEFF-based approach derived from the ESC-recommended diagnostic algorithm. We evaluated the impact of NT-proBNP thresholds on HFpEF classification and explored the relationship between NT-proBNP, echocardiographic diastolic dysfunction, and structural cardiac abnormalities. Results: The cohort displayed a high cardiometabolic burden (74.9%), and structural cardiac abnormalities were highly prevalent. Using a modified HFA-PEFF diagnostic algorithm, HFpEF was identified in 52.9% of patients. However, when the biomarker domain was excluded, 86.7% of patients remained within the intermediate-probability range. In an exploratory analysis, a cutoff of 700 pg\/mL was identified as the cohort-adapted threshold with the best diagnostic balance and identified 19.8% patients as having HFpEF. Conclusions: Patients with CKD G3\u2013G4 exhibited substantial structural and functional cardiovascular abnormalities despite no prior diagnosis of heart failure. HFpEF classification varied according to the NT-proBNP threshold applied, while NT-proBNP demonstrated limited discriminatory performance for echocardiographic diastolic dysfunction. These findings support the need for more refined and CKD-sensitive approaches for HFpEF characterization in this population.<\/jats:p>","DOI":"10.3390\/life16060944","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T03:37:29Z","timestamp":1780544249000},"page":"944","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["HFpEF Diagnosis: A Challenge in CKD with Current Algorithms"],"prefix":"10.3390","volume":"16","author":[{"given":"Anca E.","family":"Stefan","sequence":"first","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Dr. C. I. Parhon Clinical Hospital, 700503 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria A.","family":"Covic","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Cardiovascular Diseases Institute Prof. Dr. George I.M. Georgescu, 700503 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5551-6077","authenticated-orcid":false,"given":"Gianina","family":"Dodi","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9361-1922","authenticated-orcid":false,"given":"Alexandra E.","family":"Avanu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3933-5172","authenticated-orcid":false,"given":"Silviu","family":"B\u00eergoan","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Cardiovascular Diseases Institute Prof. Dr. George I.M. Georgescu, 700503 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corneliu","family":"Moro\u0219anu","sequence":"additional","affiliation":[{"name":"Dr. C. I. Parhon Clinical Hospital, 700503 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amin","family":"Bazyani","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Koc University School of Medicine, 34450 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1297-0675","authenticated-orcid":false,"given":"Mehmet","family":"Kanbay","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Koc University School of Medicine, 34450 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radu A.","family":"Sascau","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Cardiovascular Diseases Institute Prof. Dr. George I.M. Georgescu, 700503 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9985-2486","authenticated-orcid":false,"given":"Adrian C.","family":"Covic","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Dr. C. I. Parhon Clinical Hospital, 700503 Iasi, Romania"},{"name":"Academy of Romanian Scientists, 030171 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2461","DOI":"10.1016\/S0140-6736(25)01853-7","article-title":"Global, regional, and national burden of chronic kidney disease in adults, 1990\u20132023, and its attributable risk factors: A systematic analysis for the Global Burden of Disease Study 2023","volume":"406","author":"Mark","year":"2025","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1159\/000534071","article-title":"Disease Burden and Epidemiological Trends of Chronic Kidney Disease at the Global, Regional, National Levels from 1990 to 2019","volume":"148","author":"Ying","year":"2023","journal-title":"Nephron"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2017","DOI":"10.1093\/cvr\/cvad083","article-title":"Cardiovascular complications in chronic kidney disease: A review from the European Renal and Cardiovascular Medicine Working Group of the European Renal Association","volume":"119","author":"Zoccali","year":"2023","journal-title":"Cardiovasc. 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