In the Journals

Patients with CKD at increased risk for adverse CV events, biomarkers may aid in identification

Horng H. Chen

Two cardiac biomarkers may be useful prognostic indicators of adverse cardiovascular events in patients with chronic kidney disease, a population that researchers determined has an increased risk for myocardial infarction, congestive heart failure and stroke.

“Cardiovascular disease (CVD) has long been identified as the major cause of premature death in CKD, even with mildly impaired renal function,” Shravya Vinnakota, MBBS, of the Mayo Clinic in Rochester, and colleagues wrote. “This can be explained in part by shared common risk factors including hypertension, diabetes, hyperlipidemia, smoking and obesity. However, there is growing evidence that impaired kidney function and raised albuminuria levels are risk factors independent of traditional factors, such as hypertension and diabetes. In addition, there are pathologic mechanisms that are unique to CKD that promote vascular disease, thus contributing to the increased burden of CVD.”

Horng H. Chen, MD, of the department of cardiovascular diseases at the Mayo Clinic, told Healio/Nephrology that “the utility of [high-sensitivity troponin T] hs-TnT and [N-terminal pro B-type natriuretic peptide] NT-proBNP has been questioned in chronic kidney disease, as these markers are cleared by the kidneys and their elevated values could simply be related to impaired kidney function.”

To characterize cardiac biomarker levels and cardiovascular outcomes, researchers conducted a retrospective review of 1,819 Minnesota residents who were aged 45 years or older (6.4% with CKD; 52.3% with mild renal insufficiency [defined as 60 mL/min/1.73m2 to 89 mL/min/1.73m2]; 41.3% with normal renal function). They noted that, at baseline, participants with CKD were older and had a higher incidence of hypertension, diabetes and myocardial infarction. The interactions between NT-proBNP and hs-TnT and eGFR were also assessed, with a mean follow-up of 10.2 years.

Someone clutching heart 
Two cardiac biomarkers may be useful prognostic indicators of adverse cardiovascular events in patients with chronic kidney disease.
Source: Adobe Stock

Researchers found that CKD was associated with an increased risk for myocardial infarction (HR = 1.95), as well as composite cardiovascular outcomes (myocardial infarction, congestive heart failure, stroke and all-cause mortality [HR = 1.38]).

Regarding NT-proBNP and hs-TnT, those with the highest levels were at a greater risk of adverse cardiovascular outcomes and no interaction between eGFR and either of the biomarkers was observed. Patients with CKD had significantly elevated cardiac biomarkers compared with those with mild renal insufficiency or normal renal function.

“Further studies are required to confirm the prognostic value of cardiac biomarkers like high-sensitivity troponin and NT-proBNP and to establish cutoffs based on the patient’s kidney function,” Chen said. “The next step in research would involve clinical trials with CKD patients identified to be at an increased cardiovascular risk using the above-mentioned biomarkers and randomizing them to aggressive cardiovascular risk modification strategies to assess for improvement in long-term and short-term cardiovascular outcomes.” – by Melissa J. Webb

Disclosure: Chen reports research funding from NIH-NHLBI and being co-founder of Zumbro Discovery.

Horng H. Chen

Two cardiac biomarkers may be useful prognostic indicators of adverse cardiovascular events in patients with chronic kidney disease, a population that researchers determined has an increased risk for myocardial infarction, congestive heart failure and stroke.

“Cardiovascular disease (CVD) has long been identified as the major cause of premature death in CKD, even with mildly impaired renal function,” Shravya Vinnakota, MBBS, of the Mayo Clinic in Rochester, and colleagues wrote. “This can be explained in part by shared common risk factors including hypertension, diabetes, hyperlipidemia, smoking and obesity. However, there is growing evidence that impaired kidney function and raised albuminuria levels are risk factors independent of traditional factors, such as hypertension and diabetes. In addition, there are pathologic mechanisms that are unique to CKD that promote vascular disease, thus contributing to the increased burden of CVD.”

Horng H. Chen, MD, of the department of cardiovascular diseases at the Mayo Clinic, told Healio/Nephrology that “the utility of [high-sensitivity troponin T] hs-TnT and [N-terminal pro B-type natriuretic peptide] NT-proBNP has been questioned in chronic kidney disease, as these markers are cleared by the kidneys and their elevated values could simply be related to impaired kidney function.”

To characterize cardiac biomarker levels and cardiovascular outcomes, researchers conducted a retrospective review of 1,819 Minnesota residents who were aged 45 years or older (6.4% with CKD; 52.3% with mild renal insufficiency [defined as 60 mL/min/1.73m2 to 89 mL/min/1.73m2]; 41.3% with normal renal function). They noted that, at baseline, participants with CKD were older and had a higher incidence of hypertension, diabetes and myocardial infarction. The interactions between NT-proBNP and hs-TnT and eGFR were also assessed, with a mean follow-up of 10.2 years.

Someone clutching heart 
Two cardiac biomarkers may be useful prognostic indicators of adverse cardiovascular events in patients with chronic kidney disease.
Source: Adobe Stock

Researchers found that CKD was associated with an increased risk for myocardial infarction (HR = 1.95), as well as composite cardiovascular outcomes (myocardial infarction, congestive heart failure, stroke and all-cause mortality [HR = 1.38]).

Regarding NT-proBNP and hs-TnT, those with the highest levels were at a greater risk of adverse cardiovascular outcomes and no interaction between eGFR and either of the biomarkers was observed. Patients with CKD had significantly elevated cardiac biomarkers compared with those with mild renal insufficiency or normal renal function.

“Further studies are required to confirm the prognostic value of cardiac biomarkers like high-sensitivity troponin and NT-proBNP and to establish cutoffs based on the patient’s kidney function,” Chen said. “The next step in research would involve clinical trials with CKD patients identified to be at an increased cardiovascular risk using the above-mentioned biomarkers and randomizing them to aggressive cardiovascular risk modification strategies to assess for improvement in long-term and short-term cardiovascular outcomes.” – by Melissa J. Webb

Disclosure: Chen reports research funding from NIH-NHLBI and being co-founder of Zumbro Discovery.