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Stein NR, Zelnick LR, Anderson AH, Christenson RH, deFilippi CR, Deo R, Go AS, He J, Ky B, Lash JP, Seliger SL, Soliman EZ, Shlipak MG, Bansal N. Associations Between Cardiac Biomarkers and Cardiac Structure and Function in CKD. Kidney Int Rep 2020; 5:1052-1060. [PMID: 32647762 PMCID: PMC7335964 DOI: 10.1016/j.ekir.2020.04.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction Subclinical changes to cardiac structure and function detected with echocardiography precede the development of clinical heart failure (HF) in persons with chronic kidney disease (CKD). Circulating cardiac biomarkers may reflect these pathophysiological changes. This study investigated associations between established biomarkers (N-terminal pro-B-type natriuretic peptide [NT-proBNP] and high-sensitivity troponin T [hsTnT]) and novel biomarkers (growth differentiation factor 15 [GDF-15], galectin-3 [Gal-3], and soluble ST-2 [sST-2]), using echocardiographic measurements in persons with CKD. Methods In cross-sectional analyses among 2101 participants with mild to moderate CKD in the Chronic Renal Insufficiency Cohort (CRIC), biomarker levels measured at baseline were evaluated with echocardiographic measurements 1 year later. These included left ventricular mass index (LVMI), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), and left atrial diameter (LAD). Multivariable linear regression analyses tested associations of each biomarker with echocardiographic measurements, adjusting for covariates. Results GDF-15 was significantly associated with higher LVMI (1.0 g/m2.7; 95% CI, 0.4–1.7), LVESV (0.4 ml/m2.7; 95% CI, 0.0–0.7), and LVEDV (0.6 ml/m2.7; 95% CI, 0.1–1.1), but not with LVEF or LAD. These findings were not significant when adjusting for NT-proBNP and hsTnT. Gal-3 and sST-2 had no significant associations. Higher levels of NT-proBNP and hsTnT were associated with all echocardiographic measurements. Conclusion In patients with CKD, the novel biomarker GDF-15, a marker of inflammation and tissue injury, and clinical biomarkers NT-proBNP and hsTnT, were associated with echocardiographic measurements of subclinical cardiovascular disease. Collectively, these biomarkers may highlight biological pathways that contribute to the development of clinical HF.
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Affiliation(s)
- Nathan R Stein
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Leila R Zelnick
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Amanda H Anderson
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Robert H Christenson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Rajat Deo
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alan S Go
- Division of Research, Kaiser Permanente, Oakland, California, USA
| | - Jiang He
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Bonnie Ky
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James P Lash
- Department of Medicine, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Stephen L Seliger
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Elsayed Z Soliman
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael G Shlipak
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Nisha Bansal
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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