Emrich IE, et al. - Researchers hypothesized that high plasma neprilysin loses its ability to predict cardiac events in chronic kidney disease (CKD) patients, considering that natriuretic peptides may inhibit plasma neprilysin and they tend to accumulate in CKD. Predefined endpoints of hospitalization for acute decompensated heart failure and incident atherosclerotic cardiovascular events were assessed among CKD G2–G4 patients within the CARE FOR HOMe study. In CKD, neprilysin activity could be inhibited by high natriuretic peptides, a finding in line with experimental studies. The adverse cardiovascular outcome in CKD patients was not predicted by high neprilysin activity and concentrations. Therefore, cautious implementation of neprilysin inhibitors in patients with advanced CKD was recommended.