The serum biomarker N-terminal pro-B–type natriuretic peptide (NT-proBNP) is released by cardiomyocytes primarily in response to mechanical stress or stretch. NT-proBNP is frequently assessed in adults with chronic kidney disease (CKD) to gain insights into disease mechanisms, improve risk stratification, and guide therapy.1 However, NT-proBNP is poorly described in pediatric CKD. Therefore, we sought to define the distribution and clinical determinants of NT-proBNP in a large, diverse, and well-phenotyped pediatric CKD cohort.