While NT-proBNP accumulation with worsening renal function poses an intrinsic limitation of this biomarker, it was shown that the decline in kidney function during therapy for acute decompensated heart failure is associated with improved outcomes as long as NT-proBNP levels are decreasing, supporting the incorporation of congestive HF biomarker as guidance for interpreting acute declines in kidney function among patients admitted for acute decompensated HF [37]. This evidence concerns the gene NPPB and hydrops fetalis.