Related Experiment Video
Updated: Nov 26, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Change in Cardiac Biomarkers and Risk of Incident Heart Failure and Atrial Fibrillation in CKD: The Chronic Renal
Nisha Bansal1, Leila R Zelnick1, Elsayed Z Soliman1
1Kidney Research Institute, University of Washington, Seattle, WA.
Insights
Increases in N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) and soluble ST-2 (sST2) correlate with higher risks of heart failure (HF) and atrial fibrillation (AF) in chronic kidney disease (CKD) patients.
Area of Science:
- Cardiology
- Nephrology
- Biomarker Research
Background:
- Circulating cardiac biomarkers are crucial for understanding heart failure (HF) and atrial fibrillation (AF) mechanisms.
- Single biomarker measurements show strong links to incident HF and AF in chronic kidney disease (CKD).
- Longitudinal changes in biomarkers may offer deeper insights into cardiovascular disease (CVD) progression in CKD.
Purpose of the Study:
- To investigate the association between longitudinal changes in specific cardiac biomarkers and the risk of incident HF and AF in patients with CKD.
- To assess the predictive value of changes in NT-proBNP, hsTnT, galectin-3, GDF-15, and sST2 for future HF and AF events.
Main Methods:
- Employed a case-cohort study design within the Chronic Renal Insufficiency Cohort (CRIC) study.
- Measured biomarkers at baseline and 2-year follow-up in adults with CKD.
- Utilized Cox proportional hazards regression to analyze associations between biomarker change categories and incident HF/AF.
Main Results:
- Increased NT-proBNP levels over 2 years were linked to higher risks of both incident HF and AF.
- Elevated sST2 levels were associated with increased HF risk, while decreased sST2 levels correlated with higher AF risk.
- No significant associations were found between changes in hsTnT, galectin-3, or GDF-15 and incident HF or AF.
Conclusions:
- Longitudinal increases in NT-proBNP and sST2 are significant predictors of incident HF and AF in the CKD population.
- These findings highlight the potential of monitoring biomarker dynamics for risk stratification in CKD patients.
- Further research is warranted to explore therapeutic strategies targeting these biomarkers to mitigate CVD risk in CKD.
Rationale & Objective:
Circulating cardiac biomarkers may signal potential mechanistic pathways involved in heart failure (HF) and atrial fibrillation (AF). Single measures of circulating cardiac biomarkers are strongly associated with incident HF and AF in chronic kidney disease (CKD). We tested the associations of longitudinal changes in the N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hsTnT), galectin-3, growth differentiation factor 15 (GDF-15), and soluble ST-2 (sST-2) with incident HF and AF in patients with CKD.
Study Design:
Observational, case-cohort study design.
Setting & Participants:
Adults with CKD enrolled in the Chronic Renal Insufficiency Cohort study.
Exposures:
Biomarkers were measured at baseline and 2 years later among those without kidney failure. We created 3 categories of absolute change in each biomarker: the lowest quartile, the middle 2 quartiles, and the top quartile.
Outcomes:
The primary outcomes were incident HF and AF.
Analytical Approach:
Cox proportional hazards regression models were used to test the associations of the change categories of each cardiac biomarker with each outcome (with the middle 2 quartiles of change as the referent group), adjusting for potential confounders and baseline concentrations of each biomarker.
Results:
The incident HF analysis included 789 participants (which included 138 incident HF cases), and the incident AF analysis included 774 participants (123 incident AF cases). In multivariable models, the top quartile of NT-proBNP change (>232pg/mL over 2years) was associated with increased risk of incident HF (HR, 1.79 [95% CI, 1.06-3.04]) and AF (HR, 2.32 [95% CI, 1.37-3.93]) compared with the referent group. Participants in the top quartile of sST2 change (>3.37ng/mL over 2years) had significantly greater risk of incident HF (HR, 1.89 [95% CI, 1.13-3.16]), whereas those in the bottom quartile (≤-3.78ng/mL over 2years) had greater risk of incident AF (HR, 2.43 [95% CI, 1.39-4.22]) compared with the 2 middle quartiles. There was no association of changes in hsTnT, galectin-3, or GDF-15 with incident HF or AF.
Limitations:
Observational study.
Conclusions:
In CKD, increases in NT-proBNP were significantly associated with greater risk of incident HF and AF, and increases in sST2 were associated with HF. Further studies should investigate whether these markers of subclinical cardiovascular disease can be modified to reduce the risk of cardiovascular disease in CKD.
More Related Videos
Related Concept Videos
01:24Chronic Kidney Disease II: Clinical Manifestations
01:25Chronic Kidney Disease I: Introduction
01:18Chronic Kidney Disease IV: Nursing Management
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:28Chronic Kidney Disease III: Interprofessional Care
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...