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Author
Wang, KeZelnick, Leila R.
Anderson, Amanda
Cohen, Jordana
Dobre, Mirela
Deo, Rajat
Feldman, Harold
Go, Alan
Hsu, Jesse
Jaar, Bernard
Kansal, Mayank
Shlipak, Michael
Soliman, Elsayed
Rao, Panduranga
Weir, Matt
Bansal, Nisha
Appel, Lawrence J.
Feldman, Harold I.
Go, Alan S.
He, Jiang
Lash, James P.
Rao, Panduranga S.
Rahman, Mahboob
Townsend, Raymond R.
Date
2020-09-09Journal
Kidney International ReportsPublisher
Elsevier Ltd.Type
Article
Metadata
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Introduction: Cardiovascular disease (CVD) is the leading cause of mortality among individuals with chronic kidney disease (CKD). Cardiac biomarkers of myocardial distention, injury, and inflammation may signal unique pathways underlying CVD in CKD. In this analysis, we studied the association of baseline levels and changes in 4 traditional and novel cardiac biomarkers with risk of all-cause, CV, and non-CV mortality in a large cohort of patients with CKD. Methods: Among 3664 adults with CKD enrolled in the Chronic Renal Insufficiency Cohort Study, we conducted a cohort study to examine the associations of baseline levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), cardiac high-sensitivity troponin T (hsTnT), growth differentiation factor−15 (GDF-15), and soluble ST-2 (sST-2) with risks of all-cause and cardiovascular (CV) mortality. Among a subcohort of 842 participants, we further examined the associations between change in biomarker levels over 2 years with risk of all-cause mortality. We used Cox proportional hazards regression models and adjusted for demographics, kidney function measures, cardiovascular risk factors, and medication use. Results: After adjustment, elevated baseline levels of each cardiac biomarker were associated with increased risk of all-cause mortality: NT-proBNP (hazard ratio [HR] = 1.92, 95% confidence interval [CI] = 1.73−2.12); hsTnT (HR = 1.62, 95% CI = 1.48, 1.78]); GDF-15 (HR = 1.61, 95% CI = 1.46−1.78]); and sST-2 (HR = 1.26, CI = 1.16−1.37). Higher baseline levels of all 4 cardiac biomarkers were also associated with increased risk of CV. Declines in NT-proBNP (adjusted HR = 0.55, 95% CI = 0.36−0.86) and sST2 (HR = 0.55, 95% CI = 0.36−0.86]) over 2 years were associated with lower risk of all-cause mortality. Conclusion: In a large cohort of CKD participants, elevations of NT-proBNP, hsTnT, GDF-15, and sST-2 were independently associated with greater risks of all-cause and CV mortality.Sponsors
Johns Hopkins UniversityIdentifier to cite or link to this item
http://hdl.handle.net/10713/13958ae974a485f413a2113503eed53cd6c53
10.1016/j.ekir.2020.08.028