Cardiac Biomarkers Identify High-Risk Kidney Disease Patients

Cardiovascular disease (CVD) claims more lives in people with chronic kidney disease (CKD) than complications of kidney disease and this can be explained in part by shared common risk factors including hypertension, diabetes, hyperlipidemia, smoking, and obesity.

However, there is growing evidence that impaired kidney function and raised albuminuria levels are risk factors for CVD independent of traditional factors such as hypertension and diabetes. In addition, there are pathologic mechanisms that are unique to CKD that promote vascular disease, thus contributing to the increased burden of CVD.

Cardiologists from the Mayo Clinic (Rochester, MN, USA) classified participants by renal function, characterize trends of cardiac biomarker activation and left ventricular function, and report cardiovascular outcomes over a 10-year follow-up period using data from a retrospective study, including 1,981 participants from the Olmsted County Heart Function Study. Participants were aged 45 years and older between January 1997 and December 2000, and had had a clinical evaluation, medical record review, laboratory tests, and echocardiogram. Follow-up was a median 10.2 years.

Age/sex-adjusted baseline characteristics, tertiles of N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hs-TnT) and their interactions with eGFR were examined. Outcomes measured included incident myocardial infarction (MI), congestive heart failure, stroke, and all-cause mortality. The prevalence of stage 3 CKD (eGFR < 60 mL/min/1.73m²) was 6.4% (126/1,981). In the remainder of the group, 52.3% (1,036/1,981) had mild renal insufficiency (eGFR 60-89 mL/min/1.73m²) and 41.3% (819/1,981) had normal kidney function.

The physicians reported that the degree of kidney impairment, as estimated by eGFR, did not significantly affect the results, suggesting renal impairment was not the only reason for elevation of the biomarkers. The analysis suggested an optimal cut-point for the overall study group of 97.1 pg/mL for NT-proBNP and 3.8 ng/L for hs-TnT; these values were similar to the third tertile for both biomarkers. Over a 10.2-year follow-up period, CKD was associated with an increased risk of myocardial infarction (MI) and composite cardiovascular outcomes including MI, congestive heart failure, stroke, and all-cause mortality.

Horng H. Chen, MB, BCh, a cardiologist and senior author of the study, said, “In this study we demonstrated that NT-proBNP and hs-TnT have prognostic value regardless of kidney function. Hence, these two biomarkers can be used to help clinicians, identify patients with kidney disease who are at highest risk for adverse cardiac events and who would be candidates for aggressive risk factor modification to prevent adverse outcomes.” The study was published on October 23, 2019 in the journal Mayo Clinic Proceedings.

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