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Renal Biomarkers in Heart Failure: Systematic Review and Meta-Analysis

Amudha Kumar1, Vignesh Chidambaram2, Harinivas Shanmugavel Geetha3

  • 1Division of Cardiology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois, USA.

JACC. Advances
|June 28, 2024
PubMed

Insights

Serum cystatin C and NGAL predict adverse outcomes in heart failure (HF) patients. These renal biomarkers, including KIM-1, are crucial for predicting mortality, hospitalizations, and worsening renal function (WRF) in HF.

Area of Science:

  • Cardiology
  • Nephrology
  • Biomarker Research

Background:

  • Cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule (KIM)-1 are recognized renal biomarkers for heart failure (HF) risk stratification.
  • Clinical adoption of these biomarkers is limited due to inconsistencies in their application and interpretation.

Purpose of the Study:

  • To investigate the association between serum cystatin C, NGAL, KIM-1, and clinical outcomes in patients with acute and chronic HF.
  • To evaluate the predictive value of these biomarkers for mortality, hospitalizations, and worsening renal function (WRF).

Main Methods:

  • A systematic review and random-effects meta-analysis of peer-reviewed English-language articles from PubMed and EMBASE up to December 2021.
  • Inclusion of 100 articles comprising 45,428 patients to analyze biomarker associations with HF outcomes.
  • Assessment of publication bias using funnel plots.

Main Results:

  • Elevated serum cystatin C (top tertile vs. bottom) was associated with increased mortality (pHR: 1.59) and a composite of mortality and HF hospitalizations (pHR: 1.49).
  • Higher serum NGAL levels indicated increased mortality (pHR: 2.91) and composite outcomes (HR: 4.11).
  • Both serum and urine NGAL predicted WRF (pHRs 2.40 and 2.01, respectively), while urine KIM-1 predicted WRF (pHR: 1.60) but not other outcomes. High heterogeneity was observed.

Conclusions:

  • Serum cystatin C and serum NGAL are independent predictors of adverse outcomes in HF patients.
  • Serum and urine NGAL are significant predictors of worsening renal function (WRF) in the context of HF.
Abstract

Keywords:
KIM-1NGALcystatin Ctubular injuryworsening renal function

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