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Cardiac biomarkers and survival in haemodialysis patients
C Sommerer1, J Beimler, V Schwenger
1University Hospital of Heidelberg, Heidelberg, Germany. claudia.sommerer@med.uni-heidelberg.de
Insights
Elevated cardiac troponin T (cTNT) and amino-terminal pro-B-natriuretic peptide (NT-proBNP) levels in dialysis patients are linked to fluid overload and predict increased cardiac events. These biomarkers aid risk stratification in end-stage renal disease.
Area of Science:
- Cardiology
- Nephrology
- Biomarker Research
Background:
- Dialysis patients often exhibit elevated cardiac troponin T (cTNT) and amino-terminal pro-B-natriuretic peptide (NT-proBNP) without acute myocardial ischemia.
- These elevations are more pronounced compared to non-dialysis individuals, suggesting a link to the dialysis process or underlying conditions.
Purpose of the Study:
- To investigate the association between cTNT and NT-proBNP levels and cardiovascular morbidity and mortality in haemodialysis patients.
- To determine the influence of fluid overload on these biomarker levels and their predictive capacity.
Main Methods:
- Measured plasma cTNT and NT-proBNP in 134 haemodialysis patients before and after dialysis.
- Assessed patient volume status using a clinical score system.
- Monitored cardiovascular morbidity and mortality over a 36-month follow-up period.
Main Results:
- Elevated cTNT (>0.03 ng mL⁻¹) was found in 39.6% of patients; hypervolaemic patients had significantly higher cTNT levels.
- All patients showed high NT-proBNP levels, with significantly higher levels in hypervolaemic individuals.
- cTNT > 0.026 ng mL⁻¹ and NT-proBNP > 5300 pg mL⁻¹ predicted hypervolaemia and were associated with increased cardiac mortality.
Conclusions:
- Plasma cTNT and NT-proBNP levels are frequently elevated in asymptomatic chronic haemodialysis patients and are dependent on volume status.
- Both biomarkers are strongly associated with adverse cardiovascular outcomes in end-stage renal disease patients undergoing haemodialysis.
- Elevated cTNT and NT-proBNP serve as valuable tools for cardiovascular risk stratification in this population.
Background:
In dialysis patients, cardiac troponin T (cTNT) is often elevated despite the absence of acute myocardial ischaemia, and amino-terminal pro-B-natriuretic peptide (NT-proBNP) is markedly higher compared to non-haemodialysis patients. In a longitudinal observation, we evaluated the association of cTNT and NT-proBNP on cardiovascular morbidity and mortality in haemodialysis patients with and without fluid overload.
Materials And Methods:
Plasma cTNT levels of 134 haemodialysis patients were measured before and after a dialysis session by 3rd generation electro-chemoluminiscence immunoassay. NT-proBNP was determined using a polyclonal antibody recognizing the N-terminal fragment of BNP (Elecsys autoanalyzer 2010, Roche Diagnostics, Mannheim, Germany). Volume status was determined by a clinical score system. Cardiovascular morbidity and mortality were assessed over a follow-up period of 36 months.
Results:
Plasma cTNT > 0.03 ng mL(-1) was found in 39.6% of all patients. Patients with hypervolaemia had significantly higher cTNT levels compared to euvolaemic patients (median 0.054 ng mL(-1), interquartile range 0.019-0.153 vs. 0.005 ng mL(-1), < 0.001-0.034; P < 0.001). All haemodialysis patients had excessively high levels of NT-proBNP (median 4524; interquartile range 2000-10 250 pg mL(-1)), and NT-proBNP was significantly higher in hypervolaemic haemodialysis patients (11 988, 5307-19 242) compared to euvolaemic haemodialysis patients (3247, 1619-5574); P < 0.001. Receiver operator curves showed a threshold of cTNT > 0.026 ng mL(-1) and NT-proBNP > 5300 pg mL(-1) as predictors of hypervolaemia. Asymptomatic chronic haemodialysis patients with cTNT > 0.026 ng mL(-1) and NT-proBNP > 5300 pg mL(-1) were more likely to die due to cardiac events in the follow-up period. Multivariate analysis documented that elevated cTNT and NT-proBNP levels were highly predictive for cardiovascular events.
Conclusions:
Plasma levels of cTNT are elevated in approximately 40% and NT-proBNP levels in 100% of asymptomatic chronic haemodialysis patients. Both parameters depend on volume status. Increased NT-proBNP and cTNT are strongly associated with adverse outcome in end-stage renal disease patients undergoing haemodialysis, and are a useful tool for risk stratification in chronic haemodialysis patients.
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