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Cardiac Biomarkers Predict Major Adverse Cardiac Events (MACE) in Incident Haemodialysis Patients: Results from a
Elin Mitford Davies1,2,3, Benjamin J R Buckley4,5, Philip Austin6
1Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK.
Insights
Routine blood biomarkers like Troponin I and BNP can predict major adverse cardiac events (MACE) in patients starting hemodialysis (HD). This finding highlights the need for better cardiovascular risk assessment in incident HD patients.
Area of Science:
- Cardiology
- Nephrology
- Biomarkers
Background:
- Hemodialysis (HD) is linked to significant cardiovascular events, particularly in new patients.
- Current methods lack specific risk stratification for incident HD patients.
- Blood biomarkers offer insights into myocardial injury and stress.
Purpose of the Study:
- To assess the association between elevated circulating biomarker concentrations in incident HD patients and the occurrence of major adverse cardiac events (MACE).
- To evaluate the predictive value of Troponin I and BNP for MACE in this population.
Main Methods:
- Retrospective cohort study using the TriNetX database of incident HD patients within 3 months of treatment initiation.
- Patients grouped by biomarker thresholds: Troponin I (≥50 ng/L) and BNP (≥100 pg/mL).
- 1:1 propensity-score matching for demographics, baseline CV risk, labs, and medications; Cox regression analysis.
Main Results:
- Included 62,206 patients for Troponin I and 10,476 for BNP.
- Elevated Troponin I associated with MACE (HR 1.33, 95% CI 1.26-1.41, p < 0.0001).
- Elevated BNP associated with MACE (HR 1.28, 95% CI 1.13-1.44, p < 0.0001).
Conclusions:
- Routine clinical laboratory biomarkers (Troponin I, BNP) can predict incident MACE in patients starting hemodialysis.
- Results indicate a clinical need for cardiovascular mortality and morbidity risk profiling in incident HD.
- Combined clinical and laboratory variables may improve risk stratification for these patients.
Abstract:
Background: Despite its many advantages, haemodialysis (HD) has been shown to be associated with significant cardiovascular events, especially in patients commencing HD. Currently, there is no specific method to risk-stratify incident HD patients. Blood-based biomarkers provide insight into myocardial injury and stress. We aimed to evaluate the association of increased circulating biomarker concentration in incident HD with incident major adverse cardiac events (MACE). Methods: This was a retrospective cohort study of incident haemodialysis cases within 3 months of treatment initiation (≥18 years) from the TriNetX database. Cohorts were grouped by biomarker thresholds: Troponin I: ≥50 ng/L, BNP ≥ 100 pg/mL and 1:1 propensity-score matched for demographic characteristics, baseline cardiovascular risk, laboratory values, and cardiovascular medication. Primary outcome: Incidence of major adverse cardiac events (MACE) censored prior to index event of HD. Secondary outcome: Risk of each individual component of the composite outcome. Cox regression reported hazard ratios (95% CI) for the outcomes. Results: In total, 62,206 and 10,476 patients were included in the troponin I and BNP cohorts, respectively. In the troponin I cohort, 5878 developed MACE (HR 1.33 (95% CI 1.26-1.41, p < 0.0001)). In the BNP cohort, 1050 developed MACE (HR 1.28 (95% CI 1.13-1.44, p < 0.0001)). Conclusions: In incident HD, routine clinical laboratory biomarkers can predict incident MACE. The results suggest the clinical need for CV mortality and morbidity risk profiling in incident HD using a combination of clinical and laboratory variables.
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