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NT-proBNP: is it a more significant risk factor for mortality than troponin T in incident hemodialysis patients?
Hyung Jung Oh1, Mi Jung Lee, Hye Sun Lee
1From the Department of Internal Medicine, College of Medicine, Brain Korea 21 for Medical Science, Severance Biomedical Science Institute, Yonsei University, Seoul, Korea (HJO, MJL, JTP, SHH, T-HY, S-WK); Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea (Y-LK); Department of Internal Medicine, Seoul National University of Medicine, Seoul, Korea (YSK); Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, Seoul, Korea (CWY); Department of Medicine, Chonnam National University Medical School, Gwangju, Korea (N-HK); and Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea (HSL).
Insights
N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) predict cardiovascular death in incident hemodialysis patients. NT-proBNP offers the most prognostic value for mortality risk in these patients.
Area of Science:
- Nephrology
- Cardiology
- Biomarker Research
Background:
- Cardiac biomarkers predict mortality in End-Stage Renal Disease (ESRD) patients.
- Previous studies often had limitations: retrospective design, small cohorts, prevalent patients only, or limited biomarker analysis.
Purpose of the Study:
- To prospectively analyze the association between three cardiac biomarkers and mortality in incident hemodialysis (HD) patients.
- To determine the incremental prognostic value of NT-proBNP, cTnT, and hsCRP beyond traditional risk factors.
Main Methods:
- Prospective cohort study of 864 incident HD patients followed for 30 months.
- Patients stratified into 'high' and 'low' groups based on median baseline NT-proBNP, cTnT, and hsCRP.
- Comparison of cardiovascular (CV) and all-cause mortality between groups; time-dependent ROC curves, Net Reclassification Improvement (NRI), and Integrated Discrimination Improvement (IDI) calculated.
Main Results:
- Higher NT-proBNP and cTnT levels were associated with significantly lower CV survival rates.
- No significant difference in CV survival for hsCRP groups.
- All-cause mortality rates were significantly higher in the 'high' groups for all three biomarkers.
- NT-proBNP was identified as an independent predictor of mortality in multivariate analyses and showed superior prognostic ability compared to cTnT.
Conclusions:
- NT-proBNP is a valuable prognostic marker for both CV and all-cause mortality in incident HD patients.
- NT-proBNP provides the most added prognostic value beyond traditional risk factors.
- This study highlights the importance of NT-proBNP in risk stratification for hemodialysis patients.
Abstract:
Numerous studies have demonstrated that cardiac biomarkers are significant predictors of cardiovascular (CV) and all-cause mortality in ESRD patients, but most of the studies were retrospective or included small numbers of patients, only prevalent dialysis patients, or measured 1 or 2 biomarkers. This study was to analyze the association between 3 cardiac biomarkers and mortality in incident HD patients. A prospective cohort of 864 incident HD patients was followed for 30 months. Based on the median values of baseline NT-proBNP, cTnT, and hsCRP, the patients were divided into "high" and "low" groups, and CV and all-cause mortality were compared between each group. Additionally, time-dependent ROC curves were constructed, and the NRI and IDI of the models with various biomarkers were calculated. The CV survival rates were significantly lower in the "high" NT-proBNP and cTnT groups compared to the corresponding "low" groups, while there was no significant difference in CV survival rate between the 2 hsCRP groups. However, all-cause mortality rates were significantly higher in all 3 "high" groups compared to each lower group. In multivariate analyses, only Ln NT-proBNP was found to be an independent predictor of mortality. Moreover, NT-proBNP was a more prognostic marker for mortality compared to cTnT. In conclusion, NT-proBNP is the biomarker that results in the most added prognostic value on top of traditional risk factors for CV and all-cause mortality in incident HD patients.
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