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Twardawa M, Formanowicz P, Formanowicz D. The Interplay Between Carotid Intima-Media Thickness and Selected Serum Biomarkers in Various Stages of Chronic Kidney Disease. Biomedicines 2025; 13:335. [PMID: 40002748 PMCID: PMC11853316 DOI: 10.3390/biomedicines13020335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Revised: 01/22/2025] [Accepted: 01/25/2025] [Indexed: 02/27/2025] Open
Abstract
Background/Objectives: Chronic kidney disease (CKD), the most common cause of which is hypertension and diabetes, is a recognized risk factor for cardiovascular disease (CVD). This study investigated the association between selected serum biomarkers in the context of intima-media thickness (IMT) changes, a common predictor of subsequent cardiovascular (CV) events. Methods: A total of 251 individuals were enrolled in the study, divided into groups based on the severity of CKD, the presence of CVD, and healthy controls. For this purpose, the data from the following groups of participants were analyzed: (1) end-stage renal disease (ESRD) (n = 106), (2) pre-dialyzed (PRE) (n = 48), (3) patients at stages 1 and 2 of CKD (CKD1-2) (n = 37), (4) patients with CVD and no kidney disease (CARD) (n = 28), and (5) healthy controls (HV) (n = 31). To find markers associated with elevated IMT, the each group with CVD (ESRD, PRE and CARD) was separated into two subgroups with normal and elevated IMT and compared in the relation of the studied serum biomarkers. Results: The findings identified glucose as the only marker exclusively associated with CVD. Markers uniquely linked to CKD included urea, creatinine, eGFR, total protein, CEL, neopterin, total calcium, phosphates, iPTH, sodium, iron, ferritin, and AST. All other markers reflected a combined influence of both CKD and CVD. By comparing patients with normal and elevated IMT, distinct types of CKD-CVD interactions were observed, i.e., independent (additive effects of CKD and CVD) for MPO, ALP, MMP-9, and MMP-9/TIMP-1; combined (enhanced effect due to interactions) for AOPPs and TIMP-1; and conditional (CVD impact specific to CKD patients) for AGEs, 3-NT, magnesium, UIBC, TIBC, ALT, and TIMP-1/MMP-9. However, certain markers, i.e., CML, sRAGEs, carbamylated protein groups, protein carbamylation, hsCRP, TC, HDL-C, LDL-C, TG, IL-18, klotho, FGF-23, klotho/FGF-23 ratio, potassium, NT-proBNP, and AIP were associated with both CKD and CVD, though the exact nature of their interaction could not be determined using IMT as a distinguishing factor. Conclusions: The results showed that relations between IMT and the remaining studied factors were not trivial, and most of the analyzed parameters were altered in CKD patients, especially if compared to patients with CVD but without CKD. IMT cannot be used as a universal CVD marker.
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Affiliation(s)
- Mateusz Twardawa
- Institute of Computing Science, Poznan University of Technology, 60-965 Poznan, Poland; (M.T.); (P.F.)
- ICT Security Department, Poznan Supercomputing and Networking Center Affiliated to the Institute of Bioorganic Chemistry, Polish Academy of Sciences, 61-139 Poznan, Poland
| | - Piotr Formanowicz
- Institute of Computing Science, Poznan University of Technology, 60-965 Poznan, Poland; (M.T.); (P.F.)
| | - Dorota Formanowicz
- Department of Medical Chemistry and Laboratory Medicine, Poznan University of Medical Sciences, 60-806 Poznan, Poland
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Hansrivijit P, Chen YJ, Lnu K, Trongtorsak A, Puthenpura MM, Thongprayoon C, Bathini T, Mao MA, Cheungpasitporn W. Prediction of mortality among patients with chronic kidney disease: A systematic review. World J Nephrol 2021; 10:59-75. [PMID: 34430385 PMCID: PMC8353601 DOI: 10.5527/wjn.v10.i4.59] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/11/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a common medical condition that is increasing in prevalence. Existing published evidence has revealed through regression analyses that several clinical characteristics are associated with mortality in CKD patients. However, the predictive accuracies of these risk factors for mortality have not been clearly demonstrated. AIM To demonstrate the accuracy of mortality predictive factors in CKD patients by utilizing the area under the receiver operating characteristic (ROC) curve (AUC) analysis. METHODS We searched Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible articles through January 2021. Studies were included based on the following criteria: (1) Study nature was observational or conference abstract; (2) Study populations involved patients with non-transplant CKD at any CKD stage severity; and (3) Predictive factors for mortality were presented with AUC analysis and its associated 95% confidence interval (CI). AUC of 0.70-0.79 is considered acceptable, 0.80-0.89 is considered excellent, and more than 0.90 is considered outstanding. RESULTS Of 1759 citations, a total of 18 studies (n = 14579) were included in this systematic review. Eight hundred thirty two patients had non-dialysis CKD, and 13747 patients had dialysis-dependent CKD (2160 patients on hemodialysis, 370 patients on peritoneal dialysis, and 11217 patients on non-differentiated dialysis modality). Of 24 mortality predictive factors, none were deemed outstanding for mortality prediction. A total of seven predictive factors [N-terminal pro-brain natriuretic peptide (NT-proBNP), BNP, soluble urokinase plasminogen activator receptor (suPAR), augmentation index, left atrial reservoir strain, C-reactive protein, and systolic pulmonary artery pressure] were identified as excellent. Seventeen predictive factors were in the acceptable range, which we classified into the following subgroups: predictors for the non-dialysis population, echocardiographic factors, comorbidities, and miscellaneous. CONCLUSION Several factors were found to predict mortality in CKD patients. Echocardiography is an important tool for mortality prognostication in CKD patients by evaluating left atrial reservoir strain, systolic pulmonary artery pressure, diastolic function, and left ventricular mass index.
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Affiliation(s)
- Panupong Hansrivijit
- Department of Internal Medicine, UPMC Pinnacle, Harrisburg, PA 17104, United States
| | - Yi-Ju Chen
- Department of Internal Medicine, UPMC Pinnacle, Harrisburg, PA 17104, United States
| | - Kriti Lnu
- Department of Internal Medicine, UPMC Pinnacle, Harrisburg, PA 17104, United States
| | - Angkawipa Trongtorsak
- Department of Internal Medicine, Amita Health Saint Francis Hospital, Evanston, IL 60202, United States
| | - Max M Puthenpura
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA 19129, United States
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, United States
| | - Michael A Mao
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, United States
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, United States
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Goto J, Forsberg U, Jonsson P, Matsuda K, Nilsson B, Nilsson Ekdahl K, Henein MY, Stegmayr BG. Interdialytic weight gain of less than 2.5% seems to limit cardiac damage during hemodialysis. Int J Artif Organs 2020; 44:539-550. [PMID: 33339470 PMCID: PMC8366174 DOI: 10.1177/0391398820981385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aims: To investigate if a single low-flux HD induces a rise in cardiac biomarkers and if a change in clinical approach may limit such mechanism. Material and methods: A total of 20 chronic HD patients each underwent three different study-dialyses. Dialyzers (low-flux polysulfone, 1.8 sqm) had been stored either dry or wet (Wet) and the blood level in the venous chamber kept low or high. Laboratory results were measured at baseline, 30 and 180 min, adjusted for the effect of fluid shift. Ultrasound measured microemboli signals (MES) within the return line. Results: Hemodialysis raised cardiac biomarkers (p < 0.001): Pentraxin 3 (PTX) at 30 min (by 22%) and at 180 min PTX (53%), Pro-BNP (15%), and TnT (5%), similarly for all three HD modes. Baseline values of Pro-BNP correlated with TnT (rho = 0.38, p = 0.004) and PTX (rho = 0.52, p < 0.001). The changes from pre- to 180 min of HD (delta-) were related to baseline values (Pro-BNP: rho = 0.91, p < 0.001; TnT: rho = 0.41, p = 0.001; PTX: rho = 0.29, p = 0.027). Delta Pro-BNP (rho = 0.67, p < 0.001) and TnT (rho = 0.38, p = 0.004) correlated with inter-dialytic-weight-gain (IDWG). Biomarkers behaved similarly between the HD modes. The least negative impact was with an IDWG ⩽ 2.5%. Multiple regression analyses of the Wet-High mode does not exclude a relation between increased exposure of MES and factors such as release of Pro-BNP. Conclusion: Hemodialysis, independent of type of dialyzer storage, was associated with raised cardiac biomarkers, more profoundly in patients with higher pre-dialysis values and IDWG. A limitation in IDWG to <2.5% and prolonged ultrafiltration time may limit cardiac strain during HD, especially in patients with cardiovascular risk.
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Affiliation(s)
- Junko Goto
- Institute of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.,Department of Emergency and Critical Care Medicine, School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Ulf Forsberg
- Institute of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.,Department of Internal Medicine, Skellefteå County Hospital, Skellefteå, Sweden
| | - Per Jonsson
- Institute of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Kenichi Matsuda
- Department of Emergency and Critical Care Medicine, School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Bo Nilsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Kristina Nilsson Ekdahl
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Linnaeus Centre of Biomaterials Chemistry, Linnaeus University, Kalmar, Sweden
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Bernd G Stegmayr
- Institute of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
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Sato H, Kawasaki M, Tanaka R, Yoshizane T, Ono K, Tadokoro M, Yano Y, Kondou T, Kariya T, Nagata K, Gotoh K, Sawada S, Noda T, Watanabe S. Relationships among pulmonary capillary wedge pressure, dry weight and natriuretic peptide in patients undergoing hemodialysis: a three-dimensional speckle tracking echocardiography study. J Echocardiogr 2020; 18:160-168. [PMID: 31997088 DOI: 10.1007/s12574-020-00461-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/15/2019] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although the evaluation of fluid status in hemodialysis (HD) patients is useful, relationship among pulmonary capillary wedge pressure (PCWP), dry body weight (DW) and natriuretic peptide has not been elucidated. In addition, there has been no objective marker for instantaneously monitoring hemodynamic improvement in response to HD. We previously reported that PCWP and time constant of left ventricular pressure decline (Tau) can be noninvasively estimated (ePCWP and eTau) by speckle tracking echocardiography (STE). The aim of this study was to elucidate the relationship among ePCWP, eTau, DW and natriuretic peptide in patients undergoing HD. METHODS We measured ePCWP and body weight (BW) by STE in 81 patients and ANP and BNP by blood examination in 31 patients just before and after HD during sinus rhythm. RESULTS The ePCWP decreased after HD, and this was associated with reductions in ln ANP, eTau and BW (r = 0.523, 0.271 and 0.814, respectively, p < 0.05). The % change in ePCWP was not correlated with the % change in ln BNP (p = 0.47). The change in ePCWP had a stronger correlation with the % change in BW than the change in any other parameters. CONCLUSIONS The ePCWP is more sensitive to estimate the change in BW during HD than any other parameters such as ANP and BNP. These results indicated that a substantial amount of excess fluid can be assessed real-time by STE using ePCWP.
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Affiliation(s)
- Hidemaro Sato
- Department of Internal Medicine, Sawada Hospital, Gifu, Japan
| | - Masanori Kawasaki
- Cardiovascular Medicine, Gifu Heart Center, 4-14-4 Yabuta-minami, Gifu, 500-8384, Japan.
| | - Ryuhei Tanaka
- Department of Cardiology, Asahi University Hospital, Gifu, Japan
| | - Takashi Yoshizane
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Koji Ono
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | | | - Yoko Yano
- Department of Internal Medicine, Sawada Hospital, Gifu, Japan
| | - Takehito Kondou
- Department of Internal Medicine, Sawada Hospital, Gifu, Japan
| | - Tatsuya Kariya
- Department of Internal Medicine, Sawada Hospital, Gifu, Japan
| | - Kijun Nagata
- Department of Internal Medicine, Sawada Hospital, Gifu, Japan
| | - Koshi Gotoh
- Department of Internal Medicine, Sawada Hospital, Gifu, Japan
| | - Shigeki Sawada
- Department of Internal Medicine, Sawada Hospital, Gifu, Japan
| | - Toshiyuki Noda
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Sachiro Watanabe
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
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Otaki Y, Watanabe T, Sato N, Shirata T, Kato S, Tamura H, Nishiyama S, Arimoto T, Takahashi H, Shishido T, Morikane K, Watanabe M. Brain Natriuretic Peptide (BNP) and N-Terminal-proBNP in Cardio-Renal Anemia Syndrome ― Difference in Prognostic Ability ―. Circ Rep 2019. [DOI: 10.1253/circrep.cr-18-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yoichiro Otaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Naohito Sato
- Division of Clinical Laboratory, Yamagata University Hospital
| | - Toru Shirata
- Division of Clinical Laboratory, Yamagata University Hospital
| | - Shigehiko Kato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Harutoshi Tamura
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Satoshi Nishiyama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Takanori Arimoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Hiroki Takahashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Tetsuro Shishido
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
| | - Keita Morikane
- Division of Clinical Laboratory and Infection Control, Yamagata University Hospital
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine
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6
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Kruzan RM, Herzog CA, Wu A, Sang Y, Parekh RS, Matsushita K, Hwang S, Cheng A, Coresh J, Powe NR, Shafi T. Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study. BMC Nephrol 2016; 17:18. [PMID: 26897129 PMCID: PMC4761195 DOI: 10.1186/s12882-016-0230-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 02/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sudden cardiac death (SCD) is the most common etiology of death in hemodialysis patients but not much is known about its risk factors. The goal of our study was to determine the association and risk prediction of SCD by serum N-terminal prohormone of brain natriuretic peptide (NTproBNP) troponin I (cTnI) in hemodialysis patients. METHODS We measured NTproBNP and cTnI in 503 hemodialysis patients of a national prospective cohort study. We determined their association with SCD using Cox regression, adjusting for demographics, co-morbidities, and clinical factors and risk prediction using C-statistic and Net Reclassification Improvement (NRI). RESULTS Patients' mean age was 58 years and 54 % were male. During follow-up (median 3.5 years), there were 75 outpatient SCD events. In unadjusted and fully-adjusted models, NTproBNP had a significant association with the risk of SCD. Analyzed as a continuous variable, the risk of SCD increased 27 % with each 2-fold increase in NTproBNP (HR, 1.27 per doubling; 95 % CI, 1.13-1.43; p < 0.001). In categorical models, the risk of SCD was 3-fold higher in the highest tertile of NTproBNP (>7,350 pg/mL) compared with the lowest tertile (<1,710 pg/mL; HR for the highest tertile, 3.03; 95 % CI, 1.56-5.89; p = 0.001). Higher cTnI showed a trend towards increased risk of SCD in fully adjusted models, but was not statistically significant (HR, 1.17 per doubling; 95 % CI, 0.98-1.40; p = 0.08). Sensitivity analyses using competing risk models showed similar results. Improvement in risk prediction by adding cardiac biomarkers to conventional risk factors was greater with NTproBNP (C-statistic for 3-year risk: 0.810; 95 % CI, 0.757 to 0.864; and continuous NRI: 0.270; 95 % CI, 0.046 to 0.495) than with cTnI. CONCLUSIONS NTproBNP is associated with the risk of SCD in hemodialysis patients. Further research is needed to determine if biomarkers measurement can guide SCD risk prevention strategies in dialysis patients.
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Affiliation(s)
- Rachel M Kruzan
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Charles A Herzog
- Department of Medicine, Division of Cardiology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Aozhou Wu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore,, MD, USA
| | - Yingying Sang
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rulan S Parekh
- Departments of Medicine and Pediatrics, University of Toronto, Toronto, Canada
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore,, MD, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Seungyoung Hwang
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Alan Cheng
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Josef Coresh
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore,, MD, USA.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Departments of Medicine and Pediatrics, University of Toronto, Toronto, Canada
| | - Neil R Powe
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Tariq Shafi
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA. .,Department of Medicine, Division of Nephrology, Johns Hopkins University, 301 Mason Lord Drive, Suite, 2500, Baltimore, MD, USA.
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7
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Sivalingam M, Vilar E, Mathavakkannan S, Farrington K. The role of natriuretic peptides in volume assessment and mortality prediction in Haemodialysis patients. BMC Nephrol 2015; 16:218. [PMID: 26714753 PMCID: PMC4696232 DOI: 10.1186/s12882-015-0212-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/18/2015] [Indexed: 11/30/2022] Open
Abstract
Background Maintaining optimal fluid balance is essential in haemodialysis (HD) patients but clinical evaluation remains problematic. Other technologies such as bioimpedance are emerging as valuable adjuncts. This study was undertaken to explore the potential utility of the natriuretic peptides – atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) in the assessment of fluid status and cardiovascular risk in this setting. Methods This was a cross-sectional study carried out in an unselected cohort of 170 prevalent HD patients. Volume status was assessed by clinical parameters – the presence or absence of peripheral oedema, raised jugular venous pressure and basal lung crepitations; by extracellular fluid volume (ECFV) status determined by whole body bioimpedance; and by serum levels of BNP and ANP (pre- and post –dialysis). The relationships of ANP and BNP levels to clinical and bioimpedance parameters of volume status was determined. Patients were followed up for 5 years to assess the relationship of natriuretic peptide levels to mortality. Results Bioimpedance estimates of ECFV expansion (>105 % of ideal ECFV) was present in 52 % of patients pre-dialysis. A significant proportion (21 %) of pre-dialysis patients had a depleted ECFV (<95 % of ideal ECFV) pre-dialysis. The situation was reversed post-dialysis. A raised JVP >3 cm was the most reliable clinical sign of ECFV expansion inferred from bioimpedance measurements and natriuretic peptide levels. The vast majority of patients with this sign also had lung crepitations or peripheral oedema or both. BNP was a stronger predictor of ECFV expansion than either pre- or post-dialysis ANP. BNP was also a stronger predictor of five-year survival. Conclusion Serum levels of BNP have a strong relationship to both volume status and survival in HD patients. We found no clear role for measurement of ANP, though changes in blood levels may be a sensitive indicator of acute changes in volume status. Whether monitoring levels of these peptides has a role in the management of volume status and cardiovascular risk requires further study.
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Affiliation(s)
| | - Enric Vilar
- Renal Unit, Lister Hospital, Stevenage, Herts, SG1 4AB, UK.
| | | | - Ken Farrington
- Renal Unit, Lister Hospital, Stevenage, Herts, SG1 4AB, UK.
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Abstract
Cardiac and renal diseases often coexist and patients with cardiac and renal failure have high morbidity and mortality. Cardiorenal syndromes (CRSs) are disorders of the heart and kidneys whereby dysfunction in one organ may induce dysfunction in the other organ. Five subtypes of CRSs have been defined by the Acute Dialysis Quality Initiative Consensus Group. There is a need for early detection and monitoring of patients with CRSs. Biomarkers play a key role in the diagnosis and monitoring of acute myocardial infarction, chronic heart failure, and chronic kidney disease. In recent years, new biomarkers have been identified that may play a role in the early diagnosis of acute kidney injury. Herein, we review the use of serum and urine biomarkers in the diagnosis and management of CRSs. The established cardiac and renal biomarkers such as the cardiac troponins, natriuretic peptides, urine albumin, and creatinine, as well as the new renal biomarkers cystatin C and neutrophil gelatinase-associated lipocalin are reviewed in detail. The recent advances in assay methods, clinical studies, and recommendations in clinical guidelines are discussed. With advances in biomarker research, in future, perhaps a multimarker approach will become feasible to stratify the diagnosis of CRS for individualized treatment and prognosis.
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9
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Cheng YJ, Yao FJ, Liu LJ, Tang K, Lin XX, Li WJ, Zhang J, Wu SH. B-type natriuretic peptide and prognosis of end-stage renal disease: a meta-analysis. PLoS One 2013; 8:e79302. [PMID: 24236118 PMCID: PMC3827377 DOI: 10.1371/journal.pone.0079302] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 09/23/2013] [Indexed: 11/24/2022] Open
Abstract
Background The prognostic importance of B-type natriuretic peptide (BNP) or N-terminal pro BNP (NT-proBNP) in patients with end-stage renal disease (ESRD) remains controversial. Methodology/Principal Findings We conducted an unrestricted search from the MEDLINE and EMBASE in all languages that were published between 1966 and Augest2013. Twenty-seven long-term prospective studies met our inclusion criterias. From the pooled analysis, elevated BNP/NT-proBNP was significantly associated with increased all cause mortality [odds ratio (OR), 3.85; 95% CI, 3.11 to 4.75], cardiovascular mortality (OR, 4.05; 95% CI, 2.53 to 6.84), and cardiovascular events (OR, 7.02; 95% CI, 2.21 to 22.33). The funnel plot showed no evidence of publication bias. The corresponding pooled positive and negative likelihood ratio for prediction of all cause mortality were 1.86 (95% CI, 1.66 to 2.08) and 0.48 (95% CI, 0.42 to 0.55), respectively. Conclusions/Significance BNP/NT-proBNP is a promising prognostic tool to risk-stratify the patients with ESRD. Further investigations are warranted to elucidate the specific pathogenic mechanisms and the impact of other potential prognostic factors.
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Affiliation(s)
- Yun-Jiu Cheng
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Feng-Juan Yao
- Department of Ultrasonography, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Li-Juan Liu
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kai Tang
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Xiong Lin
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wei-Jie Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jing Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Su-Hua Wu
- Department of Cardiovascular Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- * E-mail:
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10
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Locatelli F, Hannedouche T, Martin-Malo A, Jacobson SH, Vanholder R, Ronco C, La Milia V, Lopez Gomez JM, Stefoni S, Maheut H, Klinger M, Krummel T, Dhondt A, Berdud I, Gauly A. The relationship of NT-proBNP and dialysis parameters with outcome of incident haemodialysis patients: results from the membrane permeability outcome study. Blood Purif 2013; 35:216-23. [PMID: 23548674 DOI: 10.1159/000347076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 01/10/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The association of raised levels of natriuretic peptides with elevated risk of mortality was investigated in the present analysis of the Membrane Permeability Outcome study. METHODS N-terminal probrain type natriuretic peptide (NT-proBNP) was measured in 618 incident haemodialysis patients, randomised to either high-flux or low-flux. Characteristics of patients with NT-proBNP levels below or above the median were descriptively analysed and survival analysis was performed. RESULTS Median NT-proBNP value was 2,124 pg/ml, with 1,854 pg/ml in the high-flux and 2,919 pg/ml in the low-flux group. Survival probability was lowest in patients with both a history of cardiovascular disease and NT-proBNP values above the median (p < 0.001). A multivariate Cox proportional hazard model showed interaction between presence of cardiovascular diseases and NT-proBNP levels above the median. CONCLUSIONS NT-proBNP is an independent predictor of mortality also in incident haemodialysis patients. Lower concentrations associated with high-flux dialysis suggest a possible biological link to improved survival in this group.
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Affiliation(s)
- Francesco Locatelli
- Department of Nephrology, Dialysis and Renal Transplantation, A. Manzoni Hospital, Lecco, Italy. f.locatelli @ ospedale.lecco.it
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11
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Mok SRS, Avila J, Milcarek B, Kasama R. The NT-ProBNP Test in Subjects with End-Stage Renal Disease on Hemodialysis Presenting with Acute Dyspnea: Is Knowing Worth the Cost? Emerg Med Int 2013; 2013:836497. [PMID: 23533765 PMCID: PMC3606718 DOI: 10.1155/2013/836497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 01/14/2013] [Accepted: 01/15/2013] [Indexed: 11/24/2022] Open
Abstract
Background. The NT-ProBNP/BNP test has been validated as a marker for determining the etiology of acute dyspnea. In the setting of end-stage renal disease on hemodialysis (ESRD on HD), the utility of the NT-ProBNP/BNP test has not been validated. This study examines the clinical utility of the NT-ProBNP test in the setting of ESRD on HD patients presenting with acute dyspnea. Methods. A retrospective case series of 250 subjects were admitted to Cooper University Hospital, 07/2010-03/2011, with ESRD and HD presenting with dyspnea. The incidences of echocardiography, cardiology consultation, and NT-ProBNP elevated and normal were examined. Correlation coefficients were calculated for NT-ProBNP with age (years), estimated dry weight (kg), amount of fluid removed (L), and ejection fraction (EF in %) among other echocardiography parameters. Results. Of the total sample 235 patients had NT-ProBNP levels performed. Cardiology consults were placed in 68.8% and 58% who underwent echocardiography. Of those for whom an echocardiography was performed estimated mean EFs of 54.6%, 50.8%, and 61.7% were observed among the NT-ProBNP elevated group, normal group, and no NT-ProBNP group, respectively. No differences were detected in all other echocardiography measurements. No correlation was observed between NT-ProBNP and age (r = 0.05), baseline EDW (r = -0.09), amount of fluid removed (r = 0.07), or EF (r = 0.02). Conclusion. In the setting of ESRD on HD, the NT-ProBNP test has no clinical utility in determining the etiology of acute dyspnea. This can be demonstrated through echocardiographic and therapeutic parameters measured in this study.
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Affiliation(s)
- Shaffer R. S. Mok
- Division of Internal Medicine, Department of Medicine, Cooper University Hospital, 1 Cooper Plaza, 401 Haddon Avenue, 3rd Floor, Camden, NJ 08103, USA
| | - Jose Avila
- Division of Nephrology, Department of Internal Medicine, Cooper University Hospital, 1 Cooper Plaza, 401 Haddon Avenue, 3rd Floor, Camden, NJ 08103, USA
| | - Barry Milcarek
- Division of Nephrology, Department of Internal Medicine, Cooper University Hospital, 1 Cooper Plaza, 401 Haddon Avenue, 3rd Floor, Camden, NJ 08103, USA
| | - Richard Kasama
- Division of Nephrology, Department of Internal Medicine, Cooper University Hospital, 1 Cooper Plaza, 401 Haddon Avenue, 3rd Floor, Camden, NJ 08103, USA
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12
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Breidthardt T, Burton JO, Odudu A, Eldehni MT, Jefferies H, McIntyre CW. N-Terminal Pro-B-type Natriuretic Peptide and Its Correlation to Haemodialysis-Induced Myocardial Stunning. ACTA ACUST UNITED AC 2013; 123:118-22. [DOI: 10.1159/000351190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 04/04/2013] [Indexed: 11/19/2022]
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13
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Artunc F, Mueller C, Breidthardt T, Twerenbold R, Rettig I, Usta E, Häring HU, Friedrich B. Comparison of the diagnostic performance of three natriuretic peptides in hemodialysis patients: which is the appropriate biomarker? Kidney Blood Press Res 2012; 36:172-81. [PMID: 23108497 DOI: 10.1159/000343406] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Plasma concentrations of natriuretic peptides are often elevated in chronic hemodialysis patients and difficult to interpret due to accumulation, high incidence of cardiac disease and changes in volume status. Mid-regional pro-ANP is a newly developed assay whereas BNP and its fragment NT-pro-BNP are available for a longer time. In this cross-sectional study, we compared the plasma concentration of MR-pro-ANP, BNP and NT-pro-BNP in stable ambulatory hemodialysis patients (n = 239) and investigated their associations with clinical factors such as residual diuresis, cardiac status and interdialytic weight gain and with mortality. METHODS AND RESULTS In all patients enrolled, the plasma concentration of all natriuretic peptides were largely elevated with a median concentration of 337 pg/ml (interquartile range 146-684) for BNP, 4435 pg/ml (1687-16228) for NT-proBNP and 907 pmol/L (650-1298) for MR-pro-ANP. Plasma concentration of all natriuretic peptides correlated independently with age, degree of systolic dysfunction and negatively with residual diuresis. Dependency on residual renal clearance was strongest for the fragments MR-pro-ANP and NT-pro-BNP. The plasma concentration of all natriuretic peptides was associated with mortality within 2 years of follow-up. Receiver-operated curves revealed a low sensitivity (32-45%), but high specificity for all natriuretic peptides (85-93%) resulting in a high negative predictive (82-87%). Best cut-off values obtained from were 18 611 pg/ml for NT-pro-BNP, 958 pg/ml for BNP and 1684 pmol/L for MR-pro-ANP. CONCLUSIONS In hemodialysis patients, the fragments NTproBNP and MR-pro-ANP are largely elevated compared to BNP which is explained by accumulation. The prognostic performance of MR-pro-ANP is similar to that of NT-pro-BNP or BNP.
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Affiliation(s)
- Ferruh Artunc
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University of Tübingen, Germany.
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14
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Zhou W, Ni Z, Yu Z, Shi B, Wang Q. Brain natriuretic peptide is related to carotid plaques and predicts atherosclerosis in pre-dialysis patients with chronic kidney disease. Eur J Intern Med 2012; 23:539-44. [PMID: 22863432 DOI: 10.1016/j.ejim.2012.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 05/13/2012] [Accepted: 06/04/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although brain natriuretic peptide (BNP) concentration has been associated with atherosclerosis and ischemic cardiovascular diseases (CVD) in the general population, less is known about this relationship in pre-dialysis chronic kidney disease (CKD) patients. METHODS We prospectively analyzed 227 pre-dialysis patients with CKD [median estimated glomerular filtration rate (eGFR): 28.82 (11.65-48.20) ml/min/1.73 m(2)]. At enrollment, BNP concentrations, biochemical and echocardiographic parameters were measured, and carotid artery ultrasound was performed. Patients were prospectively followed for a mean 31.8 months (range 0.5-57.0 months). Ischemic CV events and patient outcomes were recorded. RESULTS Median BNP concentration at enrollment was significantly higher in the CKD patients than in a control group [53.9 (16.2-181.0) pg/ml vs. 9.4 (7.0-15.3) pg/ml, P<0.01]. BNP concentration was positively related with the carotid intima-media thickness of the common carotid artery (CCA-IMT) and left ventricular mass index (LVMI) and was significantly higher in patients with than without carotid plaques (P<0.01). Logistic regression analysis confirmed that lgBNP concentration was independently correlated with carotid plaques. Thirty-two patients experienced ischemic cardiovascular (ICV) events during follow-up. Kaplan-Meier analysis showed that cumulative survival without new ICV events was better in patients with lower than with higher BNP concentrations (P<0.01). Cox regression analysis showed that BNP was an independent risk factor for ICV events (HR=3.167, 95%CI=1.398-7.171, P<0.01). CONCLUSIONS Similar to findings in the general population, elevated BNP level is related to atherosclerosis and an increased risk of ICV events in pre-dialytic CKD patients.
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Affiliation(s)
- Wenyan Zhou
- Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, PR China
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15
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Ouali S, Bougmiza I, Abroug S, Omezzine A, Ben Salem H, Neffeti E, Remedi F, Bouslema A, Harabi A, Boughzela E. Relationship of brain natriuretic peptide concentrations to left ventricular function and adverse outcomes in children with end-stage renal disease undergoing hemodialysis. Pediatr Cardiol 2011; 32:568-77. [PMID: 21336977 DOI: 10.1007/s00246-011-9909-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 01/31/2011] [Indexed: 11/28/2022]
Abstract
B-type natriuretic peptide (BNP) is a biomarker of cardiovascular disease that is common in adults with chronic kidney disease (CKD). However, in children with CKD, the range and predictive power of BNP concentrations are not known. We aimed to determine the effect of HD on BNP, as well as the prognostic impact of BNP, in end-stage renal disease (ESRD) children undergoing hemodialysis (HD). Thirty-five children with chronic renal failure (16 boys age 12.1 ± 3.7 years) on maintenance HD were included. BNP level was measured, and Doppler echocardiography was performed 30 min before (pre-HD BNP) and 30 min after (post-HD BNP) HD in each patient. An adverse event was defined as all-cause death and heart failure hospitalization. The median pre-HD BNP, the post-HD BNP, and the change in BNP were, respectively, 240 pg/ml (72 to 3346), 318 pg/ml (79 to 3788), and 9 pg/ml (-442 to 1889). Pre-HD BNP concentration was negatively correlated with left ventricular (LV) ejection fraction (r = -0.41, P = 0.018). During a mean follow-up of 39 ± 14 months, 6 patients died, and 3 were hospitalized for heart failure. Using univariate analysis, BNP before and after HD as well as Doppler tissue imaging velocities had a strong graded relationship with adverse events. Cox proportional hazards model demonstrated that pre-HD body weight (P = 0.008), pre-HD BNP (P = 0.011), and post-HD BNP (P = 0.038) remained independent predictors of adverse outcome. Even in case of ESRD, BNP still strongly correlated with LV systolic and diastolic dysfunction and was associated with mortality in HD children.
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Affiliation(s)
- Sana Ouali
- Department of Cardiology, Sahloul Hospital, Cité Sahloul 5054, Sousse, Tunisia.
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16
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Sivalingam M, Suresh M, Farrington K. Comparison of B-type natriuretic peptide and NT proBNP as predictors of survival in patients on high-flux hemodialysis and hemodiafiltration. Hemodial Int 2011; 15:359-65. [PMID: 21624043 DOI: 10.1111/j.1542-4758.2011.00557.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
End stage renal failure is associated with very high risk of cardiovascular disease. Serum levels of B-type natriuretic peptide (BNP) and NT proBNP reflect cardiovascular risk but it is unknown which of these peptides is a better predictor of survival in this population. BNP and NT proBNP levels and other relevant parameters were measured in 103 patients on high-flux hemodialysis (HD) and hemodiafiltration. Patients were followed for 4 years or until transplantation or death. Median BNP level was 262 pg/mL while the corresponding NT proBNP level was 362 pg/mL. Levels of these peptides were significantly lower in patients receiving hemodiafiltration than in those on high-flux HD. Only 1 of the 26 patients with normal NT proBNP died during follow-up while 3 of the 33 patients with normal BNP levels died in the same period. Both median BNP and NT proBNP levels were higher in those who died during follow-up than in those who survived 4 years. Cox Proportional Hazard models showed that both logBNP and log NT proBNP were independent predictors of survival. The area under the receiver operating characteristic curve was very similar for BNP and NT proBNP (0.779 vs. 0.781) for predicting 4-year survival. Net reclassification improvement analysis showed that adding NT proBNP to the baseline model lead to improved prediction of 4-year survival. BNP and NT proBNP levels were markedly elevated in HD patients and were highly predictive of survival. NT proBNP may have marginal advantage over BNP in predicting survival in this population.
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17
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Breidthardt T, Kalbermatter S, Socrates T, Noveanu M, Klima T, Mebazaa A, Mueller C, Kiss D. Increasing B-type natriuretic peptide levels predict mortality in unselected haemodialysis patients. Eur J Heart Fail 2011; 13:860-7. [PMID: 21628312 DOI: 10.1093/eurjhf/hfr057] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIMS Cardiac disease is the major cause of death in patients undergoing chronic haemodialysis. Recent studies have found that B-type natriuretic peptide (BNP) levels accurately reflect the cardiovascular burden of dialysis patients. However, the prognostic potential of BNP measurements in dialysis patients remains unknown. METHODS AND RESULTS The study included 113 chronic dialysis patients who were prospectively followed up. Levels of BNP were measured at baseline and every 6 months thereafter. The potential of baseline BNP and annual BNP changes to predict all-cause and cardiac mortality were assessed as endpoints. Median follow-up was 735 (354-1459) days; 35 (31%) patients died, 17 (15%) of them from cardiac causes. Baseline BNP levels were similar among survivors and non-survivors, and failed to predict all-cause and cardiac death. Cardiac death was preceded by a marked increase in BNP levels. In survivors BNP levels remained stable [median change: +175% (+20-+384%) vs. -14% (-35-+35%) over the 18 months preceding either death or the end of follow-up, P< 0.001]. Hence, annual BNP changes adequately predicted all-cause and cardiac death in the subsequent year {AUC(all-cause) = 0.70 [SD 0.05, 95% CI (0.60-0.81)]; AUC(cardiac) = 0.82 [SD 0.04, 95%CI (0.73-0.90)]}. A BNP increase of 40% provided the best cut-off level. Cox regression analysis confirmed that annual increases over 40% were associated with a seven-fold increased risk for all-cause and cardiac death. CONCLUSIONS Annual BNP increases above 40% predicted all-cause and cardiac death in the subsequent year. Hence, serially measuring BNP levels may present a novel tool for risk stratification and treatment guidance of end-stage renal disease patients on chronic dialysis.
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Affiliation(s)
- Tobias Breidthardt
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
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18
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Booth J, Pinney J, Davenport A. N-terminal proBNP--marker of cardiac dysfunction, fluid overload, or malnutrition in hemodialysis patients? Clin J Am Soc Nephrol 2010; 5:1036-40. [PMID: 20507952 DOI: 10.2215/cjn.09001209] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES N-terminal probrain type natriuretic peptide (NTproBNP) has been proven to be a valuable biomarker for predicting cardiac events and mortality in the hemodialysis population. However recent reports have suggested that NTproBNP is a marker of volume overload rather than one of cardiac dysfunction. Therefore this study investigated the effect of fluid volume status on NTproBNP. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Volume status was determined pre- and postdialysis in 72 stable hemodialysis outpatients by multifrequency bioimpedance, and the relationship to NTproBNP values was examined. RESULTS The mean and median NTproBNP values were 931.9 +/- 230 and 242 (90 to 688) pmol/L, respectively. On simple correlation, NTproBNP was associated with markers of volume overload and cardiac dysfunction. However, on logistical regression analysis, the strongest association was with the predialysis ratio of extracellular water/total body water (beta 26.6, F29.6, P = 0.000), followed by postdialysis mean arterial blood pressure (beta 0.14, F17.1, P = 0.000), dialysate calcium concentration (beta -1.19, F14.1, P = 0.002), and change in extracellular fluid volume with dialysis (beta 0.27, F7.4, P = 0.009) CONCLUSIONS In this study, NTproBNP was not associated with cardiac dysfunction as assessed by transthoracic echo or nuclear medicine scintigraphy but was dependent on factors associated with volume overload. However, because bioimpedance results can also be affected by malnutrition with loss of cell mass, NTproBNP may be elevated not only in patients with volume overload, but also those with malnutrition.
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Affiliation(s)
- John Booth
- Center for Nephrology, Royal Free Hospital, London, UK
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Blood pressure in chronic kidney disease stage 5D—report from a Kidney Disease: Improving Global Outcomes controversies conference. Kidney Int 2010; 77:273-84. [DOI: 10.1038/ki.2009.469] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Utility of natriuretic peptide testing in the evaluation and management of acute decompensated heart failure. Heart Fail Rev 2009; 15:275-91. [DOI: 10.1007/s10741-009-9141-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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