Third, elevated brain natriuretic peptide levels were observed in patients with chronic kidney disease, but without cardiovascular abnormalities.[27] In addition to the decrease in the extraction rate from blood, elevated brain natriuretic peptide levels may indicate decreasing functional renal mass and clearance receptor degradation.[28,29] Therefore, patients with higher brain natriuretic peptide levels may be more vulnerable to the nephrotoxic effect of the contrast medium. Here, NPPB is linked to chronic kidney disease.