Heart Attack Biomarkers Accurate in Chronic Kidney Disease Patients

Two blood peptide biomarkers that are indicators of heart attack in the general population also provide critical information regarding heart status in chronic kidney disease patients.

High-sensitivity troponin T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) strongly predict heart failure (HF) in the general population. However, the interpretation of levels of these biomarkers as predictors of HF was uncertain among patients with chronic kidney disease (CKD).

Investigators at the University of Washington (Seattle, USA) and the University of Pennsylvania (Philadelphia, USA) examined whether hsTnT and NT-proBNP were associated with incidents of HF among patients with CKD. In a prospective cohort analysis, they studied 3,483 people with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study who had been recruited from June of 2003 to August of 2008 and who were free of HF at time zero. The overall health of these individuals was monitored for a median of nearly six years.

Results revealed that compared with those individuals with the lowest levels of hsTnT at the start of the study, those with the highest hsTnT levels had a nearly five-fold higher risk of developing heart failure. Those with the highest NT-proBNP levels had a nearly 10-fold higher risk of developing heart failure compared with those with the lowest levels. Thus, hsTnT and NT-proBNP were shown to be strongly associated with incidents of HF among a diverse cohort of individuals with mild to severe CKD. Elevations in these biomarkers may indicate subclinical changes in volume and myocardial stress that subsequently contributed to clinical HF.

“This research is important in that it may advance the application of widely available cardiac biomarkers to identify CKD patients at the highest risk of developing heart failure, the most common cardiovascular complication in this patient population,” said first author Dr. Nisha Bansal, assistant professor of medicine at the University of Washington.

“These findings suggest that hsTnT and NT-proBNP may represent distinct biological pathways that likely involve subclinical changes in the structure and function of the heart,” said contributing author Dr. Amanda Anderson, assistant professor of biostatistics and epidemiology at the University of Pennsylvania.

The study was published in the October 2, 2014, online edition of the Journal of the American Society of Nephrology.

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