Multimarker Approach to Risk Stratification for Long-Term Mortality in Patients on Chronic Hemodialysis

Ishii, Junnichi; Kitagawa, Fumihiko; Kuno, Atsuhiro; Okuyama, Ryuunosuke; Kawai, Hideki; Muramatsu, Takashi; Naruse, Hiroyuki; Motoyama, Sadako; Matsui, Shigeru; Hasegawa, Midori; Aoyama, Toru; Kamoi, Daisuke; Kasuga, Hirotake; Izawa, Hideo

doi:10.1253/circj.cj-14-0915

Cited by 24 publications

(24 citation statements)

References 41 publications

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“…hs-CRP not only has relatively high predictive value for mortality, but testing is also readily accessible in a typical dialysis unit, and more importantly, is inexpensive373839. In the present study, we calculated AUC, NRI, and IDI to examine the clinical value of TNFR compared with hs-CRP as a reliable predictor of mortality.…”

Section: Discussionmentioning

confidence: 99%

Circulating TNF Receptors 1 and 2 Predict Mortality in Patients with End-stage Renal Disease Undergoing Dialysis

Gohda

Maruyama

Kamei

et al. 2017

Sci Rep

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Relatively high circulating levels of soluble tumor necrosis factor (TNF) receptors (TNFRs: TNFR1, TNFR2) have been associated with not only progression to end-stage renal disease but also mortality in patients with diabetes. It remains unknown whether elevated TNFR levels in haemodialysis patients are associated with mortality. We studied 319 patients receiving maintenance haemodialysis who were followed for a median of 53 months. Circulating markers of TNF pathway (TNFα and TNFRs) were measured with immunoassay. Strong positive correlations between TNFR1 and TNFR2 were observed (r = 0.81, P < 0.0001). During follow-up, 88 (27.6%) patients died of any cause (40 [45.5%] died of cardiovascular disease). In the Cox multivariate model, either TNFR but not TNFα remained a significant independent predictor of all-cause mortality (TNFR1: hazard ratio [HR] 2.34, 95% confidence interval [CI], 1.50–3.64; TNFR2: HR 2.13, 95% CI 1.38–3.29) after adjustment for age, prior cardiovascular disease, predialysis systolic blood pressure, and large systolic blood pressure decline during dialysis session. For cardiovascular mortality, significance was only observed in TNFR1 (TNFR1: HR 2.15, 95% CI 1.13–4.10). Elevated TNFRs levels were associated with the risk of cardiovascular and/or all-cause mortality independent of all relevant covariates in patients undergoing haemodialysis.

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Section: Discussionmentioning

confidence: 99%

Circulating TNF Receptors 1 and 2 Predict Mortality in Patients with End-stage Renal Disease Undergoing Dialysis

Gohda

Maruyama

Kamei

et al. 2017

Sci Rep

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“…With the widespread clinical application of standardized assays, several biomarkers and multiple biomarker approach enable the accurate prediction of the long‐term prognosis of ESKD patients treated with HD . Previous studies have demonstrated that cardiac troponin (cTn), brain‐natriuretic peptide (BNP), and C‐reactive protein (CRP) are the robust predictors of MACE independent of traditional risk factors and two‐dimensional thoracic Doppler echocardiography (TTDE) findings . However, the prognostic significance of ABI/PWV in association with biomarkers have not been fully investigated in ESKD patients.…”

Section: Introductionmentioning

confidence: 99%

Ankle‐brachial index, arterial stiffness, and biomarkers in the prediction of mortality and outcomes in patients with end‐stage kidney disease

Otsuka

Nakanishi

Shimada

et al. 2019

Clinical Cardiology

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Background Although ankle‐brachial index (ABI) and brachial‐ankle pulse wave velocity (baPWV) are significant predictors of major adverse cardiovascular event (MACE), their prognostic value in association with biomarkers has not been fully evaluated in patients with end‐stage kidney disease (ESKD). Hypothesis We hypothesized that ABI/baPWV would provide better prognostic value independent of biomarkers in ESKD patients. Methods This study included 104 ESKD patients treated with maintenance hemodialysis who underwent ABI and baPWV examinations and laboratory tests, including brain‐natriuretic peptide, high‐sensitive cardiac troponin T (hs‐cTnT), and high‐sensitive C‐reactive protein (hs‐CRP). MACE was defined as a composite event of all‐cause death, acute coronary syndrome, and stroke. Results During a mean follow‐up of 3.6 ± 1.7 years, a total of 51 MACE were observed. The independent factors associated with MACE were age >75 years (adjusted hazard ratio [HR], 2.15; P < .05), abnormal ABI (adjusted HR, 2.01; P < .05), left ventricular ejection fraction (LVEF) <50% (adjusted HR, 3.33; P < .001), the upper tertile of hs‐cTnT (adjusted HR, 2.77; P < .05), and hs‐CRP (HR, 1.96; P < .05). However, baPWV did not remain as an independent predictor of MACE in the entire cohort and also in patients without abnormal ABI. The combination of predictors improves the predictive value of MACE, providing increased HR with 4.00 for abnormal ABI + hs‐CRP, 4.42 for abnormal ABI + hs‐cTnT, and 7.04 for abnormal ABI + LVEF <50% (all P < .001). Conclusion Abnormal ABI is a robust predictor of MACE independent of biomarkers and their combination provides better risk stratification compared with a single predictor in ESKD patients.

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“…Furthermore, as we and others have already reported, the present screening strategy using cardiac biomarkers for asymptomatic coronary artery stenosis or subclinical heart failure, and frequent consultation with cardiologists, may reduce the severity or fatality rate of cardiovascular events, and such a strategy may offset the difference of the effect of referral timing on mortality. [26][27][28] The present study had several limitations. First, the sample size was relatively small and 28% of patients from the other 5 hospitals were excluded due to insufficient baseline and follow-up data.…”

Section: Discussionmentioning

confidence: 85%

Early Nephrology Referral 6 Months Before Dialysis Initiation Can Reduce Early Death But Does Not Improve Long-Term Cardiovascular Outcome on Dialysis

Hayashi

Kimura

Yasuda

et al. 2016

Circ J

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Multimarker Approach to Risk Stratification for Long-Term Mortality in Patients on Chronic Hemodialysis

Cited by 24 publications

References 41 publications

Circulating TNF Receptors 1 and 2 Predict Mortality in Patients with End-stage Renal Disease Undergoing Dialysis

Circulating TNF Receptors 1 and 2 Predict Mortality in Patients with End-stage Renal Disease Undergoing Dialysis

Ankle‐brachial index, arterial stiffness, and biomarkers in the prediction of mortality and outcomes in patients with end‐stage kidney disease

Early Nephrology Referral 6 Months Before Dialysis Initiation Can Reduce Early Death But Does Not Improve Long-Term Cardiovascular Outcome on Dialysis

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