Kidney Function Specific Reference Limits for N-terminal Pro Brain Natriuretic Peptide and High Sensitivity Troponin T: The Systolic Blood Pressure Intervention Trial

Bansal, Nisha; Katz, Ronit; Seliger, Stephen L.; deFilippi, Christopher R.; Wettersten, Nicholas; Zelnick, Leila R.; Berry, Jarett D.; Lemos, James A. de; Christenson, Robert H.; Killeen, Anthony A.; Shlipak, Michael G.; Ix, Joachim H.

doi:10.1016/j.xkme.2022.100517

Cited by 2 publications

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“…20,21 This is concordant with prior work demonstrating an association between eGFR and cardiac biomarker concentrations. 1,2,17,22 However, it does not explain the mechanism behind this finding, which has previously been attributed to impaired renal clearance of these biomarkers. Our analyses of the difference between hs-cTnT and hs-cTnI concentration and eGFR suggest that the differences between the concentrations of these biomarkers is largest at the lowest eGFR.…”

Section: Discussionmentioning

confidence: 81%

“…However, patients with CKD often have elevated troponin concentrations in the absence of active coronary ischemia or other acute pathology. 1,2 Similarly, patients with CKD often have chronically elevated NT-proBNP, which complicates the diagnosis of heart failure in this population. 3 The prevailing assumption is that reduced biomarker clearance in the setting of low glomerular filtration rate (GFR) leads to clinically insignificant elevations in plasma concentration.…”

Section: Introductionmentioning

confidence: 99%

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Association of cardiac biomarkers, kidney function, and mortality among adults with chronic kidney disease

Claudel,

Waikar,

Gopal

et al. 2023

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Background and AimsThe performance of high sensitivity troponin T (hs-cTnT), hs-cTnI, and N-terminal pro-hormone brain natriuretic peptide (NT-proBNP) in patients with chronic kidney disease (CKD) is poorly understood.MethodsWe included adults with CKD (eGFR<60 ml/min/1.73m2) in the 1999-2004 NHANES. We calculated the 99thpercentile of hs-cTnT, hs-cTnI (Abbott, Ortho, and Siemens assays), and NT-proBNP, measured the association between eGFR and cardiac biomarker concentration, and used Cox regression models to assess the relationship between cardiac biomarkers and CVD mortality.ResultsAcross 1,068 adults with CKD, the mean [SD] age was 71.9[12.7] years and 61.2% were female; 78.8% had elevated NT-proBNP and 42.6% had elevated hs-cTnT based on traditional clinical reference limits. The 99thpercentile of hs-cTnT was 122 ng/L (95% confidence interval (CI) 101-143), hs-cTnIAbbottwas 69 ng/L (95% CI 38-99), and NT-proBNP was 8952 pg/mL (95% CI 7506-10,399). A 10 ml/min decrease in eGFR was associated with greater increases in hs-cTnT and NT-proBNP than hs-cTnI (hs-cTnT: 27.5% increase (β=27.5, 95% CI 28.2-43.3)), NT-proBNP 46.0% increase (β=46.0, 95% CI 36.0-56.8), hs-cTnISiemens17.9% (β=17.9, 95% CI 9.7-26.7). Each doubling of hs-cTnT, hs-cTnI, and NT-proBNP were associated with CVD mortality (hs-cTnT HR 1.62 [95% CI 1.32-1.98],p<0.0001; hs-cTnISiemensHR 1.40 [95% CI 1.26-1.55],p<0.0001; NT-proBNP HR 1.29 [95% CI 1.19-1.41],p<0.0001).Conclusions and RelevanceCommunity dwelling adults with CKD have elevated concentrations of cardiac biomarkers, above established reference ranges. Of the troponin assays, hs-cTnI concentration appears to be most stable across eGFR categories and is associated with CVD mortality.Clinical PerspectiveWhat is new?This study investigated two important questions relevant to clinical practice. First, which cardiac biomarker (hs-cTnT or hs-cTnI) and which assay is least impacted eGFR in patients with CKD. Second, whether elevated levels of cardiac biomarkers in community-dwelling patients convey prognostic information in CKD in a more representative population.Community dwelling adults with CKD have elevated concentrations of cardiac biomarkers, above established reference ranges. Of the troponin assays, hs-CTnI concentration appears to be most stable across the eGFR categories and is associated with CVD mortality in individuals with CKD.What are the clinical implications?Community dwelling adults with CKD had elevated levels of cardiac biomarkers suggestive of subclinical myocardial injury, which were associated with increased risk of cardiovascular death.hs-cTnI was least affected by eGFR and retained prognostic significance, suggesting that it may be the superior assay for clinical use in CKD.

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