For the BW ratio, both weight loss (<25th percentile; OR, 3.47; 95% CI, 1.58-7.65) and weight gain (>75th percentile; OR, 2.33; 95% CI, 1.11-4.87) were associated with an increased likelihood of unplanned dialysis initiation.<h4>Limitations</h4>Retrospective, single-center design with possible residual confounding and limited generalizability; unavailability of body composition data.<h4>Conclusions</h4>In patients with advanced CKD, trajectories of BNP, together with BW, were significant predictors of unplanned dialysis initiation. This evidence concerns the gene NPPB and chronic kidney disease.