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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: 17] [Impact Index Per Article: 5.7] [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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2
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Interpreting troponin in renal disease: A narrative review for emergency clinicians. Am J Emerg Med 2020; 38:990-997. [DOI: 10.1016/j.ajem.2019.11.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/16/2019] [Accepted: 11/26/2019] [Indexed: 01/11/2023] Open
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3
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Determinants and Prevention of Coronary Disease in Patients With Chronic Kidney Disease. Can J Cardiol 2019; 35:1181-1187. [DOI: 10.1016/j.cjca.2019.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/09/2019] [Accepted: 05/16/2019] [Indexed: 02/06/2023] Open
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Antukh DE, Shchekochikhin DY, Nesterov AP, Gilarov MY. Diagnosis and treatment of myocardial infarction in patient with end - stage renal disease on chronic hemodialysis. TERAPEVT ARKH 2019; 91:137-144. [DOI: 10.26442/00403660.2019.06.000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Indexed: 11/22/2022]
Abstract
This review represents different aspects of myocardial infarction in patient with end - stage renal disease on chronic hemodialysis. We discuss difficulties in diagnosis, optimal method of coronary revascularization, timing of hemodialysis session, medical therapy, as well as epidemiology and prognosis. There are no unambiguous answers to these problems because patients with end - stage renal disease were excluded from most of the studies.
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Lee C, Yun HR, Joo YS, Lee S, Kim J, Nam KH, Jhee JH, Park JT, Yoo TH, Kang SW, Han SH. Framingham risk score and risk of incident chronic kidney disease: A community-based prospective cohort study. Kidney Res Clin Pract 2019; 38:49-59. [PMID: 30897893 PMCID: PMC6481968 DOI: 10.23876/j.krcp.18.0118] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/03/2018] [Accepted: 12/12/2018] [Indexed: 12/22/2022] Open
Abstract
Background Cardiovascular disease and chronic kidney disease share several common risk factors. The Framingham risk score is hypothesized to predict chronic kidney disease development. We determined if the Framingham risk scoring system can correctly predict incident chronic kidney disease in the general population. Methods This study included 9,080 subjects who participated in the Korean Genome and Epidemiology Study between 2001 and 2014 and had normal renal function. The subjects were classified into low- (< 10%), intermediate- (10-20%), and high- (> 20%) risk groups based on baseline Framingham risk scores. The primary endpoint was de novo chronic kidney disease development (estimated glomerular filtration rate [eGFR], < 60 mL/min/1.73 m2). Results During a mean follow-up duration of 8.9 ± 4.3 years, 312 (5.3%), 217 (10.8%), and 205 (16.9%) subjects developed chronic kidney disease in the low, intermediate, and high risk groups, respectively (P < 0.001). Multivariable analysis after adjustment for confounding factors showed the hazard ratios for the high- and intermediate risk groups were 2.674 (95% confidence interval [CI], 2.197-3.255) and 1.734 (95% CI, 1.447-2.078), respectively. This association was consistently observed irrespective of proteinuria, age, sex, obesity, or hypertension. The predictive power of this scoring system was lower than that of renal parameters, such as eGFR and proteinuria, but increased when both were included in the prediction model. Conclusion The Framingham risk score predicted incident chronic kidney disease and enhanced risk stratification in conjunction with traditional renal parameters in the general population with normal renal function.
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Affiliation(s)
- Changhyun Lee
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea
| | - Hae-Ryong Yun
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea
| | - Young Su Joo
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea
| | - Sangmi Lee
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea
| | - Joohwan Kim
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Heon Nam
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea.,Division of Integrated Medicine, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hyun Jhee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Jung Tak Park
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea.,Severance Biomedical Science Institute, Brain Korea 21 PLUS, Yonsei University, Seoul, Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea
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Hayashi T, Kimura T, Yasuda K, Sasaki K, Obi Y, Rakugi H, Isaka Y. Cardiac troponin T elevation at dialysis initiation is associated with all-cause and cardiovascular mortality on dialysis in patients without diabetic nephropathy. Clin Exp Nephrol 2016; 21:333-341. [PMID: 27178276 DOI: 10.1007/s10157-016-1278-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 05/02/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND It is not known whether asymptomatic cardiac troponin T (cTnT) elevation is associated with all-cause or cardiovascular mortality in non-diabetic and advanced chronic kidney disease (CKD) patients. METHODS We measured cTnT in 248 consecutive patients at 1-2 weeks before dialysis initiation between March 2005 and August 2010 and followed them prospectively. A Cox proportional hazard model was used to investigate the relationship between cTnT and all-cause and cardiovascular mortality on dialysis. RESULTS The median age of the patients was 67 years (male 59.3 %), and the prevalence of diabetic nephropathy (DN) was 38.3 %. Asymptomatic cTnT elevation (>0.01 ng/mL) was observed in 196 (79 %) and 111 (73 %) patients among the overall patients and among patients without DN, respectively. A total of 51 patients died during a median follow-up period of 31.6 months. The cTnT level was associated with all-cause [hazard ratio (HR) 1.453; 95 % confidence interval (CI) 1.093-1.931; P = 0.010] and cardiovascular mortality [HR 1.973; 95 % CI 1.127-3.454; P = 0.017] on dialysis after extensive adjustment in the overall patient population. Patients without DN showed similar associations as those for the overall patient population (all-cause mortality: HR 1.566; 95 % CI 1.048-2.339; P = 0.029 and cardiovascular mortality: HR 2.657; 95 % CI 1.115-6.328; P = 0.027). CONCLUSION Asymptomatic cTnT elevation might be strongly associated with all-cause and cardiovascular mortality in patients without DN, as well as in the overall advanced CKD patients. We suggest that cardiovascular risk in patients with pre-dialysis CKD should be stratified according to cTnT levels.
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Affiliation(s)
- Terumasa Hayashi
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi Sumiyoshi-ku, Osaka, 558-8558, Japan. .,Department of Nephrology, Rinku General Medical Center, Izumisano, Japan.
| | - Tomonori Kimura
- Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Keiko Yasuda
- Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Koichi Sasaki
- Department of Nephrology, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - Yoshitsugu Obi
- Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiromi Rakugi
- Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshitaka Isaka
- Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
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Oh HJ, Lee MJ, Kwon YE, Park KS, Park JT, Han SH, Yoo TH, Kim YL, Kim YS, Yang CW, Kim NH, Kang SW. Which Biomarker is the Best for Predicting Mortality in Incident Peritoneal Dialysis Patients: NT-ProBNP, Cardiac TnT, or hsCRP?: A Prospective Observational Study. Medicine (Baltimore) 2015; 94:e1636. [PMID: 26554763 PMCID: PMC4915864 DOI: 10.1097/md.0000000000001636] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Although numerous previous studies have explored various biomarkers for their ability to predict mortality in end-stage renal disease (ESRD) patients, these studies have been limited by retrospective analyses, mostly prevalent dialysis patients, and the measurement of only 1 or 2 biomarkers. This prospective study was aimed to evaluate the association between 3 biomarkers and mortality in incident 335 ESRD patients starting continuous ambulatory peritoneal dialysis (CAPD) in Korea. According to the baseline NT-proBNP, cTnT, and hsCRP levels, the patients were stratified into tertiles, and cardiovascular (CV) and all-cause mortalities were compared. Additionally, time-dependent ROC curves were constructed, and the net reclassification index (NRI) and integrated discrimination improvement (IDI) of the models with various biomarkers were calculated. We found the upper tertile of NT-proBNP was significantly associated with increased risk of both CV and all-cause mortalities. However, the upper tertile of hsCRP was significantly related only to the high risk of all-cause mortality even after adjustment for age, sex, and white blood cell counts. Moreover, NT-proBNP had the highest predictive power for CV mortality, whereas hsCRP was the best prognostic marker for all-cause mortality among these biomarkers. In conclusions, NT-proBNP is a more significant prognostic factor for CV mortality than cTnT and hsCRP, whereas hsCRP is a more significant predictor than NT-proBNP and cTnT for all-cause mortality in incident peritoneal dialysis patients.
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Affiliation(s)
- Hyung Jung Oh
- From the Department of Internal Medicine, College of Medicine, Brain Korea 21 for Medical Science, Severance Biomedical Science Institute, Yonsei University, Seoul (HJO, MJL, YEK, KSP, LTP, SHH, T-HY, S-WK), Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu (Y-LK), Department of Internal Medicine, Seoul National University of Medicine (YSK), Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, Seoul (CWY); and Department of Medicine, Chonnam National University Medical School, Gwangju, Korea (N-HK)
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D'Marco L, Bellasi A, Raggi P. Cardiovascular biomarkers in chronic kidney disease: state of current research and clinical applicability. DISEASE MARKERS 2015; 2015:586569. [PMID: 25944976 PMCID: PMC4402164 DOI: 10.1155/2015/586569] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 03/15/2015] [Accepted: 03/18/2015] [Indexed: 02/07/2023]
Abstract
The high incidence of cardiovascular events in chronic kidney disease (CKD) warrants an accurate evaluation of risk aimed at reducing the burden of disease and its consequences. The use of biomarkers to identify patients at high risk has been in use in the general population for several decades and has received mixed reactions in the medical community. Some practitioners have become staunch supporters and users while others doubt the utility of biomarkers and rarely measure them. In CKD patients numerous markers similar to those used in the general population and others more specific to the uremic population have emerged; however their utility for routine clinical application remains to be fully elucidated. The reproducibility and standardization of the serum assays are serious limitations to the broad implementation of these tests. The lack of focused research and validation in randomized trials rather than ad hoc measurement of multiple serum markers in observational studies is also cause for concern related to the clinical applicability of these markers. We review the current literature on biomarkers that may have a relevant role in field of nephrology.
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Affiliation(s)
- Luis D'Marco
- Unidad Avanzada de Investigación y Diagnostico Ecográfico y Renal, Clínica Puerto Ordaz, Puerto Ordaz, Venezuela
| | - Antonio Bellasi
- U.O.C. di Nefrologia e Dialisi, Ospedale Sant'Anna, Azienda Ospedaliera Sant'Anna, Como, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
- Department of Radiology, Emory University, Atlanta, GA, USA
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Walsh M, Wang CY, Ong GSY, Tan ASB, Mansor M, Shariffuddin II, Hashim NHM, Lai HY, Undok AW, Kolandaivel UN, Vajiravelu V, Garg AX, Cuerden M, Guyatt G, Thabane L, Mooney J, Lee V, Chow C, Devereaux PJ. Kidney Function Alters the Relationship between Postoperative Troponin T Level and Death. J Am Soc Nephrol 2015; 26:2571-7. [PMID: 25711126 DOI: 10.1681/asn.2014060536] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 01/13/2015] [Indexed: 11/03/2022] Open
Abstract
Cardiac troponin T (cTnT), even at low concentrations, is a risk factor for 30-day mortality in patients undergoing noncardiac surgery, but it is uncertain whether that risk is generalizable to patients with poor kidney function. We, therefore, evaluated the relationship between cTnT concentration and kidney function on the outcome of 30-day mortality in a post hoc analysis of a prospective cohort study of patients undergoing noncardiac surgery. cTnT was measured for 3 days after surgery and considered abnormal if the peak was ≥0.02 ng/ml. Of the included 14,037 patients, 267 (1.9%) patients died within 30 days of surgery. The adjusted hazard ratios for death with an abnormal cTnT concentration were 4.37 (95% confidence intervals [95% CI], 3.21 to 6.22), 6.15 (95% CI, 2.95 to 140.9), 6.30 (95% CI, 3.12 to 21.23), 1.33 (95% CI, 0.56 to 4.85), and 1.46 (95% CI, 0.46 to 9.21) for eGFR≥60, 45 to <60, 30 to <45, 15 to <30, and <15 ml/min per 1.73 m(2) or on dialysis, respectively. Compared with patients with eGFR≥60 ml/min per 1.73 m(2), the adjusted hazard ratio was significantly lower for patients with eGFR=15 to <30 ml/min per 1.73 m(2) (interaction P value=0.02). Redefining abnormal cTnT concentration as ≥0.03 ng/ml or a change of ≥0.02 ng/ml did not alter results. Because the risk associated with postoperative cTnT levels may be different for patients with eGFR<30 ml/min per 1.73 m(2), additional research is required to determine how to interpret perioperative cTnT values for patients with low kidney function.
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Affiliation(s)
- Michael Walsh
- Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, Canada;
| | | | | | | | | | | | | | | | - A Wahab Undok
- Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Amit X Garg
- Departments of Medicine and Epidemiology and Biostatistics, Western University, London, Canada
| | - Meaghan Cuerden
- Epidemiology and Biostatistics, Western University, London, Canada
| | - Gordon Guyatt
- Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Lehana Thabane
- Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - John Mooney
- Cardiac Program, George Institute for Global Health, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia; and
| | - Vincent Lee
- Centre for Transplant and Renal Research, University of Sydney at Westmead Millennium Institute, Sydney, Australia
| | - Clara Chow
- Cardiac Program, George Institute for Global Health, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia; and
| | - Phillip J Devereaux
- Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, Canada
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Voroneanu L, Siriopol D, Nistor I, Apetrii M, Hogas S, Onofriescu M, Covic A. Superior predictive value for NTproBNP compared with high sensitivity cTnT in dialysis patients: a pilot prospective observational study. Kidney Blood Press Res 2014; 39:636-47. [PMID: 25571877 DOI: 10.1159/000368452] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The clinical utility of the new biomarker, high sensitivity cardiac T troponin (hs-cTnT) is still unclear in dialysis patients. Furthermore, the prognostic value of combining N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and hs-cTnT has not been explored so far. The objective of this pilot study was to determine the utility of hs-cTnT alone versus hs-cTnT in combination with NT-proBNP for predicting death in a stable hemodialysis cohort. METHODS A prospective observational pilot study including 98 chronic asymptomatic hemodialysis patients with a follow up period of 24 months was designed. The cut-off values for NT-proBNP and hs-cTnT were calculated using receiver operating characteristic (ROC) analysis, using mortality as an end-point. Based on the cut-off values, the cohort was divided into four groups. Group 1--NT-proBNP < 14275 pg/ml and hs-cTnT < 69.48 ng/l; group 2--NT-proBNP < 14275 pg/ml and hs-cTnT > 69.48 ng/l; group 3--NT-proBNP > 14275 pg/ml and hs-cTnT < 69.48 ng/l; group 4--NT-proBNP > 14275 pg/ml and hs-cTnT > 69.48 ng/l. Survival for each group was determined using the Kaplan-Meier method and Cox regression analysis. RESULTS During the follow-up period 16 patients died. According to the ROC curves analysis, the cut-off point for hs-cTnT and for NT-proBNP were 69.43 ng/l (AUC = 0.618; p = 0.04) and 14275 pg/ml (AUC = 0.722; p = 0.003), respectively. In univariate Cox analysis, both hs-cTnT (HR = 3.34; p = 0.016) and NT-proBNP (HR = 5.94; p = 0.01) were predictors of death. In the multivariable Cox proportional hazards model, only NT-pro-BNP levels above the cut-off value remained an independent predictor of all-cause mortality. The combined elevation of both biomarkers did not improve significantly the prognostic value compared with NT-proBNP alone (HR = 6.15 versus HR =4 .78; p = 0.338). CONCLUSION NT-pro-BNP is a strong predictor of overall mortality in asymptomatic hemodialysis patients. The addition of hs-cTnT did not improve the prognostic accuracy compared with NT proBNP alone.
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Affiliation(s)
- Luminita Voroneanu
- Nephrology Clinic, Dialysis and Renal Transplant Center, C.I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
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11
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Zhao C, Luo Q, Xia X, He F, Peng F, Yu X, Huang F. Risk score to predict mortality in continuous ambulatory peritoneal dialysis patients. Eur J Clin Invest 2014; 44:1095-103. [PMID: 25263820 DOI: 10.1111/eci.12344] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 09/23/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with continuous ambulatory peritoneal dialysis (CAPD) have high all-cause mortality risk that varies extensively among different conditions. The objective of this study was to develop and validate risk models to predict the 2-year all-cause mortality risks of CAPD patients. MATERIAL AND METHODS A total of 1354 patients who received CAPD treatment > 3 months from a single dialysis centre were enrolled into the study from January 1, 2006 to December 31, 2011 and followed up until June 30, 2013. The dataset was randomly divided into the derivation dataset (2/3, n = 903) and the validation dataset (1/3, n = 451). Baseline information, including demographic characteristics, comorbid conditions and laboratory data, was recorded and included in the models. Risk models were developed using Cox proportional hazards regression. C-statistic, Akaike Information Criterion, Hosmer-Lemeshow χ(2) test and net reclassification improvement (NRI) were performed to evaluate model prediction and validation. RESULTS During the entire follow-up period, 175 (19·38%) and 85 (18·85%) patients died in the derivation and validation datasets respectively. A model that included age, diabetes mellitus, hypertension, cardiovascular disease, diastolic blood pressure, serum albumin, serum creatinine, phosphate, haemoglobin and fasting blood glucose demonstrated good discrimination in the derivation and validation datasets to predict 2-year all-cause mortality (C-statistic, 0·790 and 0·759, respectively). In the validation dataset, the above model performed good calibration (χ(2) = 2·08, P = 0·98) and NRI (7·37% compared with model 2, P = 0·05). CONCLUSIONS The risk model can accurately predict 2-year all-cause mortality in Chinese CAPD patients and external validation is needed in future.
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Affiliation(s)
- Chen Zhao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, Guangdong Provincial Key Laboratory of Nephrology Guangzhou, Guangdong, China
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de Jager DJ, Vervloet MG, Dekker FW. Noncardiovascular mortality in CKD: an epidemiological perspective. Nat Rev Nephrol 2014; 10:208-14. [DOI: 10.1038/nrneph.2014.8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Hassan HC, Howlin K, Jefferys A, Spicer ST, Aravindan AN, Suryanarayanan G, Hall BM, Cleland BD, Wong JK, Suranyi MG, Makris A. High-Sensitivity Troponin as a Predictor of Cardiac Events and Mortality in the Stable Dialysis Population. Clin Chem 2014; 60:389-98. [DOI: 10.1373/clinchem.2013.207142] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
High-sensitivity cardiac troponin T (hs-cTnT) is a biomarker used in diagnosing myocardial injury. The clinical utility and the variation of this biomarker over time remain unclear in hemodialysis (HD) and peritoneal dialysis (PD) patients. We sought to determine whether hs-cTnT concentrations were predictive of myocardial infarction (MI) and death and to examine hs-cTnT variability over a 1-year period.
METHODS
A total of 393 nonacute HD and PD patients (70% HD and 30% PD) were followed in a prospective observational study for new MI and death.
RESULTS
Median hs-cTnT was 57 ng/L (interquartile range, 36–101 ng/L) with no observed difference between HD and PD patients (P = 0.11). Incremental increases in mortality (P = 0.024) and MI (P = 0.001) were observed with increasing hs-cTnT quartiles. MI incidence increased significantly across quartiles in both HD and PD patients (P = 0.012 and P = 0.025, respectively), whereas mortality increased only in HD patients (P = 0.015). For every increase of 25 ng/L in hs-cTnT, the unadjusted hazard ratio (HR) was 1.10 for mortality in the whole group (95% CI, 1.04–1.16, P = 0.001) and 1.16 for MI (95% CI, 1.08–1.23, P < 0.001). Adjusted HR for mortality was 1.07 (95% CI, 1.01–1.15, P = 0.04) and 1.14 for MI (95% CI, 1.06–1.22, P < 0.001). Changes in hs-cTnT from baseline concentrations after 1 year were minimal (55 ng/L vs 53 ng/L, P = 0.22) even in patients who had an MI (P = 0.53).
CONCLUSIONS
hs-cTnT appears to have a useful role in predicting MI and death in the dialysis population. Over a 1-year period concentrations remained stable even in patients who sustained a new cardiac event.
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Affiliation(s)
- Hicham Cheikh Hassan
- Renal Unit, Liverpool Hospital, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | | | | | - Stephen T Spicer
- Renal Unit, Liverpool Hospital, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | | | | | - Bruce M Hall
- Renal Unit, Liverpool Hospital, Sydney, Australia
| | | | | | | | - Angela Makris
- Renal Unit, Liverpool Hospital, Sydney, Australia
- University of Western Sydney, Sydney, Australia
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Shi T, Fillmore TL, Gao Y, Zhao R, He J, Schepmoes AA, Nicora CD, Wu C, Chambers JL, Moore RJ, Kagan J, Srivastava S, Liu AY, Rodland KD, Liu T, Camp DG, Smith RD, Qian WJ. Long-gradient separations coupled with selected reaction monitoring for highly sensitive, large scale targeted protein quantification in a single analysis. Anal Chem 2013; 85:9196-203. [PMID: 24004026 DOI: 10.1021/ac402105s] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Long-gradient separations coupled to tandem mass spectrometry (MS) were recently demonstrated to provide a deep proteome coverage for global proteomics; however, such long-gradient separations have not been explored for targeted proteomics. Herein, we investigate the potential performance of the long-gradient separations coupled with selected reaction monitoring (LG-SRM) for targeted protein quantification. Direct comparison of LG-SRM (5 h gradient) and conventional liquid chromatography (LC)-SRM (45 min gradient) showed that the long-gradient separations significantly reduced background interference levels and provided an 8- to 100-fold improvement in limit of quantification (LOQ) for target proteins in human female serum. On the basis of at least one surrogate peptide per protein, an LOQ of 10 ng/mL was achieved for the two spiked proteins in nondepleted human serum. The LG-SRM detection of seven out of eight endogenous plasma proteins expressed at ng/mL or subng/mL levels in clinical patient sera was also demonstrated. A correlation coefficient of >0.99 was observed for the results of LG-SRM and enzyme-linked immunosorbent assay (ELISA) measurements for prostate-specific antigen (PSA) in selected patient sera. Further enhancement of LG-SRM sensitivity was achieved by applying front-end IgY14 immunoaffinity depletion. Besides improved sensitivity, LG-SRM potentially offers much higher multiplexing capacity than conventional LC-SRM due to an increase in average peak widths (~3-fold) for a 300 min gradient compared to a 45 min gradient. Therefore, LG-SRM holds great potential for bridging the gap between global and targeted proteomics due to its advantages in both sensitivity and multiplexing capacity.
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Affiliation(s)
- Tujin Shi
- Biological Sciences Division, Pacific Northwest National Laboratory , Richland, Washington 99352, United States
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15
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Shi T, Sun X, Gao Y, Fillmore TL, Schepmoes AA, Zhao R, He J, Moore RJ, Kagan J, Rodland KD, Liu T, Liu AY, Smith RD, Tang K, Camp DG, Qian WJ. Targeted quantification of low ng/mL level proteins in human serum without immunoaffinity depletion. J Proteome Res 2013; 12:3353-61. [PMID: 23763644 DOI: 10.1021/pr400178v] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We recently reported an antibody-free targeted protein quantification strategy, termed high-pressure, high-resolution separations with intelligent selection and multiplexing (PRISM), for achieving significantly enhanced sensitivity using selected reaction monitoring (SRM) mass spectrometry. Integrating PRISM with front-end IgY14 immunoaffinity depletion, sensitive detection of targeted proteins at 50-100 pg/mL levels in human blood plasma/serum was demonstrated. However, immunoaffinity depletion is often associated with undesired losses of target proteins of interest. Herein we report further evaluation of PRISM-SRM quantification of low-abundance serum proteins without immunoaffinity depletion. Limits of quantification (LOQ) at low ng/mL levels with a median coefficient of variation (CV) of ∼12% were achieved for proteins spiked into human female serum. PRISM-SRM provided >100-fold improvement in the LOQ when compared to conventional LC-SRM measurements. PRISM-SRM was then applied to measure several low-abundance endogenous serum proteins, including prostate-specific antigen (PSA), in clinical prostate cancer patient sera. PRISM-SRM enabled confident detection of all target endogenous serum proteins except the low pg/mL-level cardiac troponin T. A correlation coefficient >0.99 was observed for PSA between the results from PRISM-SRM and immunoassays. Our results demonstrate that PRISM-SRM can successfully quantify low ng/mL proteins in human plasma or serum without depletion. We anticipate broad applications for PRISM-SRM quantification of low-abundance proteins in candidate biomarker verification and systems biology studies.
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Affiliation(s)
- Tujin Shi
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, Washington, USA
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ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations: a report of the American College of Cardiology Foundation task force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2012; 60:2427-63. [PMID: 23154053 DOI: 10.1016/j.jacc.2012.08.969] [Citation(s) in RCA: 263] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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17
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Zand Parsa AF, Abdolahi A, Mahdavimazdeh M. Is cardiac biomarkers and left ventricular function affected by chronic kidney disease? Indian Heart J 2012; 64:479-83. [PMID: 23102386 DOI: 10.1016/j.ihj.2012.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 06/26/2012] [Accepted: 08/21/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death in patients with chronic kidney disease (CKD). These patients may have high level of cardiac troponins in their serum irrelevant to acute coronary syndrome (ACS) that could have profound impact on patient's morbidity and mortality. OBJECTIVES The aim of this study was to assess the relation between level of serum creatinine (Cr) and cardiac troponins T and I, and left ventricular (LV) function (as defined by LV ejection fraction) in non-dialysis and non-acute coronary syndrome CKD patients. MATERIALS AND METHODS This is a prospective cross sectional study that includes 150 non-dialysis CKD patients without history of ACS in at least 1 month before the beginning of the study. Patients with history of CKD (serum Cr ≥1.5 mg/dl) of more than 6 months were selected. Patients with advanced multi-organ disease (lung disease, liver disease, cerebrovascular disease and peripheral vascular disease) and history of dialysis were excluded from the study. In each patient blood sample was obtained for analyzing serum Cr and cardiac troponin T and I (cTnT and cTnI). Also LV ejection fraction (LVEF) was measured by echocardiography in the same session. RESULT There was a positive non-parametric relation between serum Cr and cTnT (p = 0.028). However there were no relation between serum Cr, cTnI (p = 0.57) and LVEF (p = 0.188). CONCLUSION In patients with CKD, serum Cr level has an impact on cTnT, but has no impact on cTnI and LVEF.
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Ryu DR, Park JT, Chung JH, Song EM, Roh SH, Lee JM, An HR, Yu M, Pyun WB, Shin GJ, Kim SJ, Kang DH, Choi KB. A more appropriate cardiac troponin T level that can predict outcomes in end-stage renal disease patients with acute coronary syndrome. Yonsei Med J 2011; 52:595-602. [PMID: 21623601 PMCID: PMC3104442 DOI: 10.3349/ymj.2011.52.4.595] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Cardiac troponin T (cTnT), a useful marker for diagnosing acute myocardial infarction (AMI) in the general population, is significantly higher than the usual cut-off value in many end-stage renal disease (ESRD) patients without clinically apparent evidence of AMI. The aim of this study was to evaluate the clinical usefulness of cTnT in ESRD patients with acute coronary syndrome (ACS). MATERIALS AND METHODS Two hundred eighty-four ESRD patients with ACS were enrolled between March 2002 and February 2008. These patients were followed until death or June 2009. Medical records were reviewed retrospectively. The cut-off value of cTnT for AMI was evaluated using a receiver operating characteristic (ROC) curve. We calculated Kaplan-Meier survival curves, and potential outcome predictors were determined by Cox proportional hazard analysis. RESULTS AMIs were diagnosed in 40 patients (14.1%). The area under the curve was 0.98 in the ROC curve (p<0.001; 95% CI, 0.95-1.00). The summation of sensitivity and specificity was highest at the initial cTnT value of 0.35 ng/mL (sensitivity, 0.95; specificity, 0.97). Survival analysis showed a statistically significant difference in all-cause and cardiovascular mortalities for the group with an initial cTnT ≥0.35 ng/mL compared to the other groups. Initial serum cTnT concentration was an independent predictor for mortality. CONCLUSION Because ESRD patients with an initial cTnT concentration ≥0.35 ng/mL have a poor prognosis, it is suggested that urgent diagnosis and treatment be indicated in dialysis patients with ACS when the initial cTnT levels are ≥0.35 ng/mL.
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Affiliation(s)
- Dong-Ryeol Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Jung Tak Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hwa Chung
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Eun Mi Song
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Sun Hee Roh
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Jeong-Min Lee
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Hye Rim An
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Mina Yu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Wook Bum Pyun
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Gil Ja Shin
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Seung-Jung Kim
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Duk-Hee Kang
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Kyu Bok Choi
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
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Jaroszynski A, Wysokinski A, Bednarek-Skublewska A, Glowniak A, Ksiazek P, Sodolski T, Furmaga J, Kutarski A, Ksiazek A. The effect of a single dialysis session on spatial QRS-T angle in haemodialysis patients. Nephrol Dial Transplant 2010; 25:3723-3729. [PMID: 20466688 DOI: 10.1093/ndt/gfq247] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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20
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Garg R, Singh A, Khaja A, Martin A, Aggarwal K. How does volume status affect BNP and troponin levels as markers of cardiovascular status in peritoneal dialysis? ACTA ACUST UNITED AC 2010; 15:240-4. [PMID: 19751426 DOI: 10.1111/j.1751-7133.2009.00094.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cardiac biomarkers such as brain natriuretic peptide, amino-terminal pro-B-type natriuretic peptide (NT-proBNP), and cardiac troponin provide information on cardiovascular morbidity and mortality in patients with normal renal function. In a considerable number of chronic hemodialysis patients, both biomarkers-NT-proBNP and troponin-are elevated despite the absence of cardiac ischemia. The elevation of cardiac biomarkers in chronic hemodialysis patients is of prognostic value with respect to cardiovascular morbidity and mortality. Furthermore, they can serve as tools for volume assessment for optimization of the fluid management aspect of dialysis. However, the association of both these markers in peritoneal dialysis is not clear. Therefore, the authors reviewed the literature to examine the role of these markers in peritoneal dialysis patients both as prognostic indicators as well as tools for volume assessment.
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Affiliation(s)
- Rajeev Garg
- University of Missouri-Columbia, 65202, USA.
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21
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Jacobs LH, van de Kerkhof J, Mingels AM, Kleijnen VW, van der Sande FM, Wodzig WK, Kooman JP, van Dieijen-Visser MP. Haemodialysis patients longitudinally assessed by highly sensitive cardiac troponin T and commercial cardiac troponin T and cardiac troponin I assays. Ann Clin Biochem 2009; 46:283-90. [DOI: 10.1258/acb.2009.008197] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Elevated cardiac troponin (cTn) concentrations predict an increased mortality in patients suffering from end-stage renal disease (ESRD). This study compares the performance of a precommercial high-sensitive cTnT assay (hs-cTnT) with two contemporary cTn assays in detecting cTn elevations in ESRD patients during a six-month follow-up. Methods Thirty-two ESRD patients were followed for six months, during which cTn concentrations were assessed every two months. Baseline biomarker concentrations were compared with those in a simultaneously measured reference population of 501 healthy subjects. Results During follow-up 26 (81%), 32 (100%) and 9 (28%) of the patients showed elevated cTn concentrations according to the current cTnT, the hs-cTnT and the cTnI assays, respectively. The range of concentrations measured in each patient had a median (interquartile range) magnitude of 0.03 μg/L (0.02–0.06), 0.017 μg/L (0.011–0.029) and 0.011 μg/L (0–0.017) according to the aforementioned assays. Conclusion According to the hs-cTnT assay, all of the ESRD patients had elevated cTnT concentrations at least once during the follow-up. As elevated cTn concentrations are highly prognostic of adverse events, the use of serial measurements has thus identified additional patients at risk for such events. The fact that we find cTn concentrations to be higher in patients with a history of cardiac disease is in line with this. Additional studies in ESRD patients are needed to investigate the added diagnostic and prognostic value of the very low cTnT concentrations and variations detected only by the hs-cTnT assay.
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Affiliation(s)
| | - Jos van de Kerkhof
- Department of Internal Medicine, Division of Nephrology, University Hospital Maastricht
- Department of Internal Medicine, Division of Nephrology, Bernhoven Hospital Veghel, the Netherlands
| | | | | | - Frank M van der Sande
- Department of Internal Medicine, Division of Nephrology, University Hospital Maastricht
| | | | - Jeroen P Kooman
- Department of Internal Medicine, Division of Nephrology, University Hospital Maastricht
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Kang EW, Na HJ, Hong SM, Shin SK, Kang SW, Choi KH, Lee HY, Han DS, Han SH. Prognostic value of elevated cardiac troponin I in ESRD patients with sepsis. Nephrol Dial Transplant 2009; 24:1568-73. [PMID: 19145004 DOI: 10.1093/ndt/gfn730] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Elevated cardiac troponin (cTn) levels have been reported to predict adverse cardiovascular outcomes in asymptomatic ESRD patients. However, the prognostic value of elevated cTn levels associated with sepsis in ESRD patients is unknown. Therefore, this study aimed to elucidate the clinical implications of elevated cTnI levels in ESRD patients with sepsis. METHODS Of the 305 ESRD patients in whom cTnI was measured between January 2003 and December 2005, sepsis developed in 121 patients during follow-up. Based on cTnI levels at the onset of sepsis, patients were classified as elevated cTnI group (ET, n = 50, >0.2 ng/ml) and lower cTnI group (LT, n = 71, < or =0.2 ng/ml). Study endpoints were short- and long-term mortality. Short-term mortality was defined as death occurring within 90 days after sepsis, and patients who survived during this period were followed till death after 90 days. RESULTS Before sepsis, the median concentration of cTnI was 0.05 (0.01-3.59) ng/ml and it was significantly increased to 0.11 (0.01-22.0) ng/ml when sepsis supervened (P < 0.01). Compared to the LT group, the short-term mortality rate was significantly higher in the ET group (P < 0.05). After adjustment for age, diabetes, serum albumin and CRP levels, presence of shock and previous cardiovascular disease history, the ET group had a greater odds ratio of short-term mortality (OR 5.13, P < 0.01). In addition, the Kaplan-Meier plot for long-term survival revealed a significantly higher mortality rate in the ET group. In a multivariate Cox regression analysis, the elevation of cTnI levels was an independent determinant for long-term mortality (HR 5.90, P < 0.01). CONCLUSION This study showed that elevated cTnI levels were significantly associated with short- and long-term mortality in ESRD patients with sepsis. Therefore, elevated cTnI levels in these patients should not be overlooked and be followed for adverse outcomes.
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Affiliation(s)
- Ea Wha Kang
- Department of Internal Medicine, NHIC IIsan Hospital, Goyangshi, Gyunggi-do, Korea
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Montagnana M, Lippi G, Tessitore N, Salvagno GL, Targher G, Gelati M, Lupo A, Guidi GC. Effect of hemodialysis on traditional and innovative cardiac markers. J Clin Lab Anal 2008; 22:59-65. [PMID: 18200568 DOI: 10.1002/jcla.20210] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The diagnostic approach to acute coronary syndrome (ACS) is challenging in patients with impaired renal function since most serum biomarkers are commonly increased in this clinical setting. Cardiac troponin T (cTnT), creatine kinase isoenzyme MB (CK MB), myoglobin, and ischemia modified albumin (IMA), were assayed in 45 patients prehemodialysis (pre-HD) and posthemodialysis (post-HD), and results were adjusted for hemoconcentration. The pre-HD values of serum IMA and cTnT were above the respective diagnostic thresholds (IMA<85 K units/L; cTnT <0.03 ng/mL) in six (13%) and 27 (60%) patients undergoing chronic HD, respectively. A significant (105.0 vs. 79.0 K units/L, P<0.0001) and variable (+38%; 95% confidence interval [CI], 12-65%) increase of serum IMA was observed post-HD, whereas the other biomarkers significantly decreased (cTnT: 0.029 vs. 0.044 ng/mL, P=0.016; CK-MB: 2.33 vs. 2.50 microg/L, P<0.0001; myoglobin: 128.1 vs. 148.7 microg/L, P<0.0001). Biomarkers of myocardial injury, especially cTnT and IMA, might be used in HD patients, provided that an appropriate diagnostic interpretation is guarantee, according to individual baseine value, metabolism, and time of sampling. Moreover, IMA might be reliably applied to stratify the long-term risk of these patients, but not for diagnosing an ACS during or immediately post-HD.
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Affiliation(s)
- Martina Montagnana
- Sezione di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Ospedale Policlinico G.B. Rossi, Verona, Italy.
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Satyan S, Light RP, Agarwal R. Relationships of N-terminal pro-B-natriuretic peptide and cardiac troponin T to left ventricular mass and function and mortality in asymptomatic hemodialysis patients. Am J Kidney Dis 2007; 50:1009-19. [PMID: 18037101 DOI: 10.1053/j.ajkd.2007.08.017] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 08/27/2007] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although the cardiac biomarker troponin T (cTnT) is related strongly to mortality in patients with end-stage renal disease, the independent association of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and cTnT levels in predicting outcomes is unknown. The objective of this study is to determine factors associated with NT-pro-BNP and cTnT and determine whether these levels are associated with mortality. STUDY DESIGN Cohort study. SETTING & PARTICIPANTS Asymptomatic hemodialysis patients (n = 150) in 4 university-affiliated hemodialysis units. EXPOSURE & OUTCOMES: For cross-sectional analysis, echocardiographic variables as exposures and NT-pro-BNP and cTnT levels as outcomes; for longitudinal analysis, association of NT-pro-BNP and cTnT levels as exposures to all-cause and cardiovascular disease mortality as outcomes. RESULTS In a multivariate regression analysis, low midwall fractional shortening, a measure of poor systolic function, was an independent correlate of log NT-pro-BNP level (P < 0.01), whereas left ventricular mass index was an independent correlate of cTnT level (P < 0.01). During a median follow-up of 24 months, 46 patients died, 26 of cardiovascular causes. NT-pro-BNP levels had a strong graded relationship with all-cause (hazard ratios [HRs], 1.54, 4.78, and 4.03 for increasing quartiles; P < 0.001) and cardiovascular mortality (HRs, 2.99, 10.95, and 8.54; P < 0.01), whereas cTnT level had a weaker relationship with all-cause (HRs, 1.57, 2.32, and 3.39; P < 0.01) and cardiovascular mortality (HRs, 0.81, 2.12, and 2.14; P = 0.1). The combination of the 2 biomarker levels did not improve the association with all-cause or cardiovascular mortality compared with NT-pro-BNP level alone. NT-pro-BNP level was a marker of mortality even after adjusting for left ventricular mass index and midwall fractional shortening. LIMITATIONS Our cohort was predominantly black and of limited sample size. CONCLUSION NT-pro-BNP level strongly correlates with left ventricular systolic dysfunction and is associated more strongly with mortality than cTnT level in asymptomatic hemodialysis patients.
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Affiliation(s)
- Sangeetha Satyan
- Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN 46202, USA
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Sommerer C, Giannitsis E, Schwenger V, Zeier M. Cardiac biomarkers in haemodialysis patients: the prognostic value of amino-terminal pro-B-type natriuretic peptide and cardiac troponin T. Nephron Clin Pract 2007; 107:c77-81. [PMID: 17890874 DOI: 10.1159/000108647] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Cardiac biomarkers such as amino-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (cTNT) provide information on cardiovascular morbidity and mortality in patients with normal renal function. In a considerable number of chronic haemodialysis patients, both biomarkers - NT-proBNP and cTNT - are elevated despite the absence of cardiac ischaemia. The elevation of cardiac biomarkers in chronic haemodialysis patients is of prognostic value with respect to cardiovascular morbidity and mortality. They provide a useful rationale for the screening of occult cardiac disease and optimization of the dialysis procedure with respect to volume control.
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Affiliation(s)
- Claudia Sommerer
- Department of Nephrology, University Hospital of Heidelberg, Heidelberg, Germany.
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Brunet P, Oddoze C, Paganelli F, Indreies M, Faure V, Opris-Saveanu A, Morange S, Portugal H, Dussol B, Berland Y. Cardiac troponins I and T in hemodialysis patients without acute coronary syndrome. Int J Cardiol 2007; 129:205-9. [PMID: 17662483 DOI: 10.1016/j.ijcard.2007.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Accepted: 07/01/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is a reluctance to use cardiac troponins (cTn) for the monitoring of acute coronary syndrome (ACS) in hemodialysis (HD) patients because renal failure per se is thought to lead to increased cTn levels. The aim of this study was to analyse the proportion of patients with increased cTn levels in HD patients without ACS. METHODS cTnI was measured with the AccuTnI(trade mark) from Beckman (cTnI-B) and Troponin I Stat(trade mark) from Dade Behring (cTnI-DB) assays; cTnT was measured with the third generation assay from Roche. The study included 105 HD patients. The clinical outcomes were determined after 2.5 years. RESULTS Considering the receiver operator characteristic (ROC) cutoff, the proportion of patients with elevated cTnI-B, cTnI-DB and cTnT levels was respectively 2%, 3% and 27%. The proportion of patients with abnormal cTn values increased when a lower cutoff value was considered, based on the 99th percentile of a reference population with a coefficient of variation of less than 10% (99th percentile-10% CV cutoff). The proportion of patients with elevated values did not differ before and after the HD session. The 2.5 years mortality was associated with increased levels of cTnT but not with increased levels of cTnI. CONCLUSIONS When the ROC cutoff is applied, cTnI assays are suitable for the monitoring of ACS in HD patients. cTnT could lead to false positive diagnosis of myocardial infarction, however it is predictive of long-term mortality. The 99th percentile-10% CV cutoff does not seem appropriate in HD patients.
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Affiliation(s)
- Philippe Brunet
- Centre de Néphrologie et de Transplantation Rénale, Hôpital de la Conception, Aix-Marseille Université et Assistance-Publique Hôpitaux de Marseille, Marseille, France
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Wang AYM, Lam CWK, Wang M, Chan IHS, Goggins WB, Yu CM, Lui SF, Sanderson JE. Prognostic value of cardiac troponin T is independent of inflammation, residual renal function, and cardiac hypertrophy and dysfunction in peritoneal dialysis patients. Clin Chem 2007; 53:882-9. [PMID: 17395709 DOI: 10.1373/clinchem.2006.078378] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND We investigated whether cardiac troponin T (cTnT) independently predicted outcome and added prognostic value over other clinical risk predictors in chronic peritoneal dialysis (PD) with end-stage renal disease. METHODS Baseline cTnT, echocardiography, indices of dialysis adequacy, and biochemical characteristics were assessed in 238 chronic PD patients who were followed prospectively for 3 years or until death. RESULTS Using multivariable Cox regression analysis, cTnT remained predictive of all-cause mortality [hazard ratio 4.43, 95% CI 1.87-10.45, P = 0.001], cardiovascular death (4.12, 1.29-13.17, P = 0.017), noncardiovascular death (8.06, 1.86-35.03, P = 0.005), and fatal and nonfatal cardiovascular events (CVEs) (3.59, 1.48-8.70, P = 0.005) independent of background coronary artery disease, inflammation, residual renal function, left ventricular hypertrophy, and systolic dysfunction. cTnT alone had better predictive value than C-reactive protein (CRP) alone for mortality [area under the ROC curve (AUC) 0.774 vs 0.691; P = 0.089] and first CVE (AUC 0.711 vs 0.593; P = 0.009) at 3 years. Survival models including age, sex, and clinical, biochemical, and echocardiographic characteristics yielded AUCs of 0.813 (95% CI, 0.748-0.877), 0.800 (95% CI, 0.726-0.874), and 0.769 (95% CI, 0.708-0.830), respectively, in relation to all-cause mortality, cardiovascular death, and fatal and nonfatal cardiovascular events. After addition of cTnT, AUCs of the above models increased significantly to 0.832 (95% CI, 0.669-0.894; P = 0.0037), 0.810 (95% CI, 0.739-0.883; P = 0.0036), and 0.780 (95% CI, 0.720-0.840; P = 0.0002), respectively; no AUCs increased when CRP was added. CONCLUSIONS cTnT is an independent predictor of long-term mortality, cardiovascular death and events, and noncardiovascular death in PD patients.
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Affiliation(s)
- Angela Yee-Moon Wang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin. New Territories, Hong Kong.
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