This elevation in ESKD patients is attributed to the renal clearance of NT-proBNP, and the high prevalence of volume expansion and cardiac abnormalities such as left ventricular hypertrophy and CHF [4,7]. NT-proBNP has gained wide clinical acceptance because the assays are standardized, which makes testing variability less pronounced compared to BNP [9]. Here, NPPB is linked to congestive heart failure.