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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Clinical Application of Cardiovascular Biomarkers in Chronic Kidney Disease
Gift Echefu1, Paschalyn Ukwuani2, John Ogedegbe3
1Department of Cardiovascular Medicine, University of Tennessee Health Science Center, Memphis, TN, United States.
Insights
Biomarkers aid in understanding cardiorenal dysfunction in chronic kidney disease (CKD). Novel markers offer personalized risk assessment, but validation in CKD patients is needed.
Area of Science:
- Nephrology
- Cardiology
- Biochemistry
Background:
- Chronic kidney disease (CKD) significantly elevates cardiovascular risks, including heart failure and sudden cardiac death.
- These risks increase with CKD progression, necessitating early cardiac disease detection and management.
- Proactive screening and intervention are crucial for patients with advanced chronic renal disease.
Purpose of the Study:
- To review traditional, non-traditional, and emerging laboratory biomarkers for cardiovascular disease (CVD) screening in CKD patients.
- To explore how biomarkers enhance understanding of cardiorenal dysfunction.
- To assess the potential for personalized risk assessment and improved prognostic accuracy.
Main Methods:
- A narrative review was conducted using the Scale for the Assessment of Narrative Review Articles (SANRA).
- Literature search of PubMed, Cochrane, EMBASE, and CINAHL up to March 2025.
- Inclusion of cohort studies and randomized clinical trials on cardiac biomarkers in chronic renal disease, including dialysis patients.
Main Results:
- Biomarkers provide insights into endothelial dysfunction, hemodynamic changes, myocardial fibrosis, inflammation, and matrix remodeling.
- Multimarker strategies may offer improved prognostic accuracy over traditional risk scores.
- Biomarker interpretation in CKD is complex due to solute retention and chronic inflammation, not solely CVD mechanisms.
Conclusions:
- Traditional and novel biomarkers are valuable tools for understanding cardiorenal dysfunction and enabling personalized risk assessment in CKD.
- While promising, the therapeutic utility of these markers requires further validation through targeted research and randomized trials.
- Integrating multimarker approaches could enhance CVD screening and management strategies in chronic kidney disease.
Introduction:
Chronic kidney disease [CKD] is associated with an increased risk of cardiovascular complications, heart failure admission, chronic coronary artery disease, arrhythmias, and sudden cardiac death. The likelihood of this risk escalates with disease progression to more advanced stages. Therefore, early detection of cardiac disease, screening for risk factors, and implementing preventive and treatment options are essential in managing patients with advanced chronic renal disease.
Methods:
Scale for the Assessment of Narrative Review Articles (SANRA)8 was applied to report this narrative review. Databases including PubMed (MEDLINE), Cochrane, EMBASE, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were searched for relevant papers published up to March 2025. Cohort studies and randomized clinical trials on cardiac biomarkers in chronic renal disease, including dialysis, were included in the review.
Results And Discussion:
Traditional and novel biomarkers enhance understanding of cardiorenal dysfunction through insight into endothelial dysfunction, hemodynamic alterations, myocardial fibrosis, inflammation, and extracellular matrix remodeling, presenting opportunities for personalized risk assessment. The integration of multimarker strategies could improve prognostic accuracy compared to traditional risk scores alone. The interpretation of these biomarkers in CKD can be complex, since their elevation does not necessarily indicate pathophysiologic mechanisms leading to cardiovascular disease alone, but rather decreased urine clearance with retention of solutes and/or overall chronic inflammation associated with CKD. A key concern regarding the therapeutic usefulness of these markers arises from the lack of targeted research and validation in randomized trials.
Conclusion:
This article reviews both established traditional, non-traditional, and emerging laboratory biomarkers for the screening of cardiovascular disease in patients with CKD.
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