Multi-Biomarker Risk Stratification of N-Terminal Pro-B-Type Natriuretic Peptide, High-Sensitivity C-Reactive Protein, and Cardiac Troponin T and I in End-Stage Renal Disease for All-Cause Death

Abstract

Background:In patients with end-stage renal disease (ESRD), the ability of single and multiple biomarker monitoring to predict adverse outcomes has not been well established. This study determined the prognostic value of multiple biomarkers for all-cause death over 2 years in 399 ESRD patients. Methods:The risk of all-cause death was determined by use of multiple biomarkers based on concentrations for a reference population (normal) and cutoffs based on tertile distributions in the ESRD group. Biomarkers studied included N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hsCRP; Dade Behring and Roche assays), and cardiac troponin T (cTnT; Roche) and I (cTnI; Dade Behring and Beckman Coulter assays). Relative risks of death were estimated and survival curves computed. Results: A total of 101 deaths occurred during 594 patient-years of follow-up. Increased NT-proBNP concentrations were not predictive of death on the basis of the normal cutoffs. However, tertile analysis of NTproBNP was significantly predictive of death and had a ROC area under the curve equivalent to or better than any of the other biomarkers. Biomarkers independently predictive of survival were hsCRP (P <0.001, either assay), cTnT (P <0.05), and cTnI (Dade, P <0.05). Twoyear mortality rates were 6% (n ‫؍‬ 45) with normal hsCRP, cTnI, and cTnT concentrations; 19% (n ‫؍‬ 173) with increased hsCRP or cTnT and normal cTnI; 44%

Patient Survival After Kidney Transplantation: Relationship to Pretransplant Cardiac Troponin T Levels

“…are also strikingly related to reduced survival in patients with CKD, particularly those on dialysis (7,8). Two isoforms of cardiac troponin are used in clinical practice, troponin T and troponin I.…”

Health Outcomes Categorized by Current and Previous Definitions of Acute Myocardial Infarction in an Unselected Cohort of Troponin-Naïve Emergency Department Patients

“…In 2003, the specimens were thawed and analyzed for cardiac troponin I (cTnI) by the AccuTnI assay (Beckman Coulter Inc.) without knowledge of the previous clinical diagnoses (8,9 ). Specimen stability with the AccuTnI troponin assay after multiple freeze-thaw cycles has been well documented (10,11 ). This study received research ethics approval.…”

Relationships of N-Terminal Pro–B-Natriuretic Peptide and Cardiac Troponin T to Left Ventricular Mass and Function and Mortality in Asymptomatic Hemodialysis Patients

“…The levels of both BNP and NTproBNP are elevated in the ESRD population 4;14 . The prognostic value of BNP or NTproBNP is less well established in Very few studies have directly compared the prognostic significance of BNP or NT-proBNP and cTnT in HD patients [18][19][20] . The correlation between cTnT and left ventricular mass and function has been inconsistent in previous studies 7;21;22 .…”