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Assessment of Vascular Function in Patients With Chronic Kidney Disease
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Biomarkers of cardio-renal damage in chronic kidney disease: one size cannot fit all

Davide Bolignano, Giuseppe Coppolino

    Critical Care (London, England)
    |July 17, 2014
    PubMed

    Insights

    Biomarkers for acute kidney injury and heart failure can be unreliable in patients with chronic kidney disease. Adjusting diagnostic thresholds or using change from baseline values improves reliability in critically ill patients.

    Area of Science:

    • Nephrology
    • Cardiology
    • Critical Care Medicine

    Background:

    • Biomarkers are crucial for diagnosing acute kidney injury (AKI) and acute heart failure (AHF), especially in intensive care unit (ICU) settings.
    • Kidney function significantly influences the production and clearance of many biomarkers.
    • Chronic kidney disease (CKD) complicates the interpretation of single biomarker measurements, potentially leading to misdiagnosis.

    Purpose of the Study:

    • To evaluate the impact of chronic kidney disease on the reliability of common biomarkers used for AKI and AHF diagnosis in critically ill patients.
    • To explore alternative strategies for biomarker interpretation in patients with renal impairment.

    Main Methods:

    • Review of existing literature on biomarker performance in critically ill patients with varying degrees of renal function.
    • Analysis of diagnostic strategies considering single threshold versus delta values (change from baseline).
    • Consideration of CKD stratification for biomarker interpretation.

    Main Results:

    • Single biomarker measurements and fixed thresholds show reduced clinical reliability in the presence of CKD.
    • Delta values (change from baseline) demonstrate improved diagnostic performance compared to single measurements.
    • CKD strata-specific cutoff values may enhance diagnostic accuracy.

    Conclusions:

    • Standard biomarker interpretation requires careful consideration in critically ill patients with renal impairment.
    • Alternative approaches, including delta values and CKD-adjusted thresholds, are essential for accurate AKI and AHF diagnosis in this population.
    • Further research is needed to establish validated, CKD-specific biomarker strategies for critical care settings.

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