Cardiac Biomarkers and Noninvasive Predictors of Atherosclerosis in Chronic Peritoneal Dialysis Patients

Abstract

Background: We investigated the relationship among serum cardiac biomarkers including N-terminal pro-brain natriuretic peptide (NT-pro-BNP), cardiac troponin T (cTnT), uric acid and high-sensitive C-reactive protein (hs-CRP) and noninvasive predictors of atherosclerosis including carotid intima-media thickness (IMT), aortic stiffness (pulse wave velocity (PWV)) and transthoracic coronary flow reserve (CFR) in peritoneal dialysis (PD) patients. Methods: 37 PD patients were included in the study. We measured (1) carotid IMT, (2) PWV and augmentation index (AIx), and (3) CFR. Simultaneous measurements of serum NT-pro-BNP, cTnT, uric acid and hs-CRP were also performed. Associations among these variables were analyzed. Results: cTnT was significantly associated with carotid IMT (r = 0.747, p < 0.001), PWV (r = 0.431, p = 0.035) and CFR (r = –0.439, p = 0.007). In multivariate analysis, cTnT was a significant independent predictor of carotid IMT (β = 4.446, p < 0.001) and CFR (β = –2.272, p = 0.013). Patients with high cTnT levels (≥0.01 ng/ml) significantly hadhigher carotid IMT and PWV values. Only the aortic PWV significantly correlated with residual renal function (r = –0.574, p = 0.004). Conclusions: Serum cTnT appeared to be a useful clinical biomarker for evaluating noninvasive predictors of atherosclerosis in chronic PD patients. Arterial stiffness as determined by PWV is also correlated with residual renal function.

Alteration of Cardiovascular Structure and Function in Patients Undergoing Peritoneal Dialysis

“…The measurement of CCA IMT using high-resolution ultrasonography has been suggested as an excellent marker of subclinical atherosclerosis. However, there are few studies about CCA IMT and atherosclerosis indicating that the CCA diameter represents an indirect indicator of the stiffness of the arterial wall [25]. In our study, female gender, body mass index, C-reactive protein and ET-1 were determined as independent predictors of an increased CCA IMT, whereas serum albumin, hemoglobin, low-density lipoprotein and age were identified as predictors of rigidity of the arterial wall.…”

Early markers of cardiovascular risk in chronic kidney disease

“…Experimental models have shown that hypoxic myocardial tissue results in the production of extra BNP, suggesting that BNP could potentially serve as a biomarker of myocardial ischemia. [13][14][15]28,33 These experimental data were confirmed in a number of small-scale clinical studies, which were summarized in a meta-analysis. [13][14][15] These data indicate that Figure 1.…”

“…Although cTnT elevation is assumed to be the result of clinically silent myocardial ischemia and micro-infarctions, cTnT also has been found to be elevated in patients with heart failure in the absence of acute ischemia and in CKD patients with LVH without myocardial necrosis. 13,14 Furthermore, studies evaluating the relation between cTnT and left ventricular parameters have shown contrasting results. Mallamaci and others [34][35][36] suggested that cTnT had a significant correlation with LVH and left ventricular systolic dysfunction in 258 HD patients.…”

“…Cardiac troponin T (cTnT) is a sensitive and specific marker of ischemic myocardial damage, renally cleared, and widely used as a predictor of cardiovascular events. 13,14 Natriuretic peptides, including brain natriuretic peptide (BNP) and its equimolar secreted N-terminal fragment prohormone brain natriuretic peptide (NT-proBNP), are increased in relation to cardiac stretch and LVH and established biomarkers for the diagnosis and risk stratification of patients with CVDs and heart failure. In the past, it has been suggested that in subjects with CKD, NT-proBNP and serum cTnT levels may be falsely elevated because of decreased renal clearance, even when there are no overt signs of volume overload, LVH, or coronary artery stenosis.…”

Relation of Residual Renal Function and Peritoneal Transport Rates with Arterial Stiffness in Peritoneal Dialysis Patients

“…CANUSA study demonstrated that survival in patients on PD was affected by the presence of RRF (21) . Caliskan et al (22) in their study on PD patients reported that the risk of development of AS increased with a decreased RRF. Huang et al (23) showed an independent inverse correlation between RRF and AS determined by baPWV.…”