Prognostic efficacy of cardiac biomarkers for mortality in dialysis patients

• Published in: Internal medicine journal Vol. 39; no. 12; pp. 812 - 818
• Main Authors: Hickman, P. E., McGill, D. A., Talaulikar, G., Hiremagalur, B., Bromley, J., Rahman, A., Koerbin, G., Southcott, E., Potter, J. M.
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.12.2009
• Subjects: Aged; Biomarkers - blood; BNP; C-Reactive Protein - analysis; Cardiovascular Diseases - blood; Cardiovascular Diseases - complications; Cardiovascular Diseases - mortality; dialysis; Female; Humans; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - mortality; Male; Middle Aged; mortality; Natriuretic Peptide, Brain - blood; NT-pro-BNP; Peptide Fragments - blood; Predictive Value of Tests; Prevalence; Prognosis; Renal Dialysis - mortality; renal failure; troponin; Troponin I - blood; Troponin T - blood
• ISSN: 1444-0903; 1445-5994
• DOI: 10.1111/j.1445-5994.2009.01846.x

Background: The high prevalence of cardiovascular mortality in the end‐stage renal disease population is well established. The aim of this current study was to document the relative prognostic significance of established cardiac biomarkers troponin T (TnT), troponin I (TnI), B‐type natriuretic peptide (BNP) and N‐terminal pro‐BNP (NT‐pro‐BNP) in this population. Methods: A prospective cohort study of dialysis patients undertaken in a single tertiary centre in Australia. Relevant clinical and biochemical information was collected at entry and all patients followed up prospectively without any loss to follow up. End‐point of interest was all‐cause mortality. Statistical analysis using Cox proportional hazards was used to study relationship between competing covariates and outcome. A total of 143 patients with a mean age of 59.67 ± 15.49 years was followed up for a median duration of 30 months. Of these patients, 89.3% were white Australians of European ancestry. Twenty‐seven per cent had an established diagnosis of diabetes mellitus. The mean concentrations (±SD) of TnT, TnI, BNP and N‐terminal peptide pro‐BNP (NT‐pro‐BNP) were 0.08 ± 0.04 µg/L, 0.09 ± 0.2 µg/L, 270 ± 117 ng/L and 1434 ± 591 ng/L respectively. Results: Twenty‐eight subjects died during the period of follow up. By univariate analysis, all cardiac markers (TnT, TnI, BNP, NT‐pro‐BNP and C‐reactive protein) were significantly associated with an increase in mortality. On Cox proportionate hazards analysis, only albumin and NT‐pro‐BNP showed a significant association with mortality, with hazard ratios of 0.834, 95% confidence interval (CI) 0.779–0.893, P < 0.001, and 1.585, 95%CI 1.160–20165, P = 0.004 respectively. Conclusion: In patients with end‐stage renal failure on dialysis NT‐pro‐BNP provides greater prognostic information compared with TnT and TnI.