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. 2020 Sep 10;5(11):2002-2012.
doi: 10.1016/j.ekir.2020.08.028. eCollection 2020 Nov.

Cardiac Biomarkers and Risk of Mortality in CKD (the CRIC Study)

Ke Wang  1   2 , Leila R Zelnick  1   2 , Amanda Anderson  3 , Jordana Cohen  4   5 , Mirela Dobre  6 , Rajat Deo  5   7 , Harold Feldman  5 , Alan Go  8 , Jesse Hsu  5 , Bernard Jaar  9 , Mayank Kansal  10 , Michael Shlipak  11 , Elsayed Soliman  12 , Panduranga Rao  13 , Matt Weir  14 , Nisha Bansal  1   2 ; CRIC Study Investigators
Collaborators, Affiliations

Cardiac Biomarkers and Risk of Mortality in CKD (the CRIC Study)

Ke Wang et al. Kidney Int Rep. .

Abstract

Introduction: Cardiovascular disease (CVD) is the leading cause of mortality among individuals with chronic kidney disease (CKD). Cardiac biomarkers of myocardial distention, injury, and inflammation may signal unique pathways underlying CVD in CKD. In this analysis, we studied the association of baseline levels and changes in 4 traditional and novel cardiac biomarkers with risk of all-cause, CV, and non-CV mortality in a large cohort of patients with CKD.

Methods: Among 3664 adults with CKD enrolled in the Chronic Renal Insufficiency Cohort Study, we conducted a cohort study to examine the associations of baseline levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), cardiac high-sensitivity troponin T (hsTnT), growth differentiation factor-15 (GDF-15), and soluble ST-2 (sST-2) with risks of all-cause and cardiovascular (CV) mortality. Among a subcohort of 842 participants, we further examined the associations between change in biomarker levels over 2 years with risk of all-cause mortality. We used Cox proportional hazards regression models and adjusted for demographics, kidney function measures, cardiovascular risk factors, and medication use.

Results: After adjustment, elevated baseline levels of each cardiac biomarker were associated with increased risk of all-cause mortality: NT-proBNP (hazard ratio [HR] = 1.92, 95% confidence interval [CI] = 1.73-2.12); hsTnT (HR = 1.62, 95% CI = 1.48, 1.78]); GDF-15 (HR = 1.61, 95% CI = 1.46-1.78]); and sST-2 (HR = 1.26, CI = 1.16-1.37). Higher baseline levels of all 4 cardiac biomarkers were also associated with increased risk of CV. Declines in NT-proBNP (adjusted HR = 0.55, 95% CI = 0.36-0.86) and sST2 (HR = 0.55, 95% CI = 0.36-0.86]) over 2 years were associated with lower risk of all-cause mortality.

Conclusion: In a large cohort of CKD participants, elevations of NT-proBNP, hsTnT, GDF-15, and sST-2 were independently associated with greater risks of all-cause and CV mortality.

Keywords: cardiac biomarkers; cardiovascular; mortality.

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Figures

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Graphical abstract
Figure 1
Figure 1
(a) Rates of all-cause mortality, by biomarker category. (b) Rates of cardiovascular (CV) mortality, by biomarker category. GDF-15, growth differentiation factor−15; hsTNT, high-sensitivity troponin T; NT-proBNP, N-terminal pro-B-type natriuretic peptide; pys, person-years; sST-2, soluble ST-2.
Figure 1
Figure 1
(a) Rates of all-cause mortality, by biomarker category. (b) Rates of cardiovascular (CV) mortality, by biomarker category. GDF-15, growth differentiation factor−15; hsTNT, high-sensitivity troponin T; NT-proBNP, N-terminal pro-B-type natriuretic peptide; pys, person-years; sST-2, soluble ST-2.
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References

    1. Saran R., Robinson B., Abbott K.C. US Renal Data System 2016 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2017;69:7–8. - PMC - PubMed
    1. Porter A.C., Lash J.P., Xie D. Predictors and outcomes of health-related quality of life in adults with CKD. Clin J Am Soc Nephrol. 2016;11:1154–1162. - PMC - PubMed
    1. Go A.S., Chertow G.M., Fan D. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–1305. - PubMed
    1. Muntner P., He J., Chen J. Prevalence of non-traditional cardiovascular disease risk factors among persons with impaired fasting glucose, impaired glucose tolerance, diabetes, and the metabolic syndrome: analysis of the Third National Health and Nutrition Examination Survey (NHANES III) Ann Epidemiol. 2004;14:686–695. - PubMed
    1. Wattanakit K., Coresh J., Muntner P. Cardiovascular risk among adults with chronic kidney disease, with or without prior myocardial infarction. J Am Coll Cardiol. 2006;48:1183–1189. - PubMed