Use of Cardiac Biomarkers in End-Stage Renal Disease

Wang, Angela Yee-Moon; Lai, Kar‐Neng

doi:10.1681/asn.2008010012

Cited by 183 publications

(151 citation statements)

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“…The association between impaired renal function and cardiovascular disease (CVD) is well established in the general population, particularly for severe levels of renal impairment [1][2][3][4][5][6]. As such, >50% of all deaths among individuals with end-stage renal disease are related to a CVD event [7].…”

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confidence: 99%

“…The relationship between renal impairment and CVD is complex and may be mediated through a variety of different pathways [3,6,14]. These include accelerated coronary and cerebrovascular atherosclerosis (which may be mediated in part by increased inflammation and oxidative stress) atrial fibrillation, and ventricular hypertrophy, which are common at severe levels of renal impairment and may, similar to electrolyte abnormalities, promote dysrhythmias, resulting in stroke or sudden cardiac death [3,[15][16][17][18][19][20].…”

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confidence: 99%

“…These include accelerated coronary and cerebrovascular atherosclerosis (which may be mediated in part by increased inflammation and oxidative stress) atrial fibrillation, and ventricular hypertrophy, which are common at severe levels of renal impairment and may, similar to electrolyte abnormalities, promote dysrhythmias, resulting in stroke or sudden cardiac death [3,[15][16][17][18][19][20]. Finally, renal impairment and CVD are known to share a common underlying risk factor profile, which includes hypertension, diabetes, dyslipidemia, smoking, injection drug use, obesity, ongoing inflammation, and black African origin [20,21].…”

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confidence: 99%

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Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals: The D:A:D Study

et al. 2016

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Background. While the association between renal impairment and cardiovascular disease (CVD) is well established in the general population, the association remains poorly understood in human immunodeficiency virus (HIV)-positive individuals.Methods. Individuals with ≥2 estimated glomerular filtration rate (eGFR) measurements after 1 February 2004 were followed until CVD, death, last visit plus 6 months, or 1 February 2015. CVD was defined as the occurrence of centrally validated myocardial infarction, stroke, invasive cardiovascular procedures, or sudden cardiac death.Results. During a median follow-up duration of 8.0 years (interquartile range, 5.4-8.9 years) 1357 of 35 357 individuals developed CVD (incidence rate, 5.2 cases/1000 person-years [95% confidence interval {CI}, 5.0-5.5]). Confirmed baseline eGFR and CVD were closely related with 1.8% of individuals (95% CI, 1.6%-2.0%) with an eGFR > 90 mL/minute/1.73 m 2 estimated to develop CVD at 5 years, increasing to 21.1% (95% CI, 6.6%-35.6%) among those with an eGFR ≤ 30 mL/minute/1.73 m 2 . The strong univariate relationship between low current eGFR and CVD was primarily explained by increasing age in adjusted analyses, although all eGFRs ≤ 80 mL/minute/1.73 m 2 remained associated with 30%-40% increased CVD rates, and particularly high CVD rates among individuals with an eGFR ≤ 30 mL/minute/1.73 m 2 (incidence rate ratio, 3.08 [95% CI, 2.04-4.65]).Conclusions. Among HIV-positive individuals in a large contemporary cohort, a strong relation between confirmed impaired eGFR and CVD was observed. This finding highlights the need for renal preventive measures and intensified monitoring for emerging CVD, particularly in older individuals with continuously low eGFRs.

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Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals: The D:A:D Study

et al. 2016

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“…Finally, one interesting alternative recently described in the context of CKD is the use of cardiac biomarkers, such as troponin T and NT-pro-brain natriuretic peptide (NT-pro-BNP). These plasma biomarkers proved to be useful for diagnostic and prognostic purposes in myocardiopathy related to more advanced stages of CKD (18). Although they do not replace CMRI or ECHO-based imaging methods, these surrogate markers may ultimately progress to play an adjunctive role in assessing cardiovascular risk of CKD subjects (18).…”

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confidence: 99%

Left Ventricular Mass in Chronic Kidney Disease and ESRD

Glassock

Pecoits‐Filho

Barberato

2009

Clinical Journal of the American Society of Nephrology

324

279

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Chronic kidney disease (CKD) and ESRD, treated with conventional hemo-or peritoneal dialysis are both associated with a high prevalence of an increase in left ventricular mass (left ventricular hypertrophy [LVH]), intermyocardial cell fibrosis, and capillary loss. Cardiac magnetic resonance imaging is the best way to detect and quantify these abnormalities, but M-Mode and 2-D echocardiography can also be used if one recognizes their pitfalls. The mechanisms underlying these abnormalities in CKD and ESRD are diverse but involve afterload (arterial pressure and compliance), preload (intravascular volume and anemia), and a wide variety of afterload/preload independent factors. The hemodynamic, metabolic, cellular, and molecular mediators of myocardial hypertrophy, fibrosis, apoptosis, and capillary degeneration are increasingly well understood. These abnormalities predispose to sudden cardiac death, most likely by promotion of electrical instability and re-entry arrhythmias and congestive heart failure. Current treatment modalities for CKD and ESRD, including thrice weekly conventional hemodialysis and peritoneal dialysis and metabolic and anemia management regimens, do not adequately prevent or correct these abnormalities. A new paradigm of therapy for CKD and ESRD that places prevention and reversal of LVH and cardiac fibrosis as a high priority is needed. This will require novel approaches to management and controlled interventional trials to provide evidence to fuel the transition from old to new treatment strategies. In the meantime, key management principles designed to ameliorate LVH and its complications should become a routine part of the care of the patients with CKD and ESRD.

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“…The elevated risk of patients with chronic heart failure supports the theory of underlying irreversible pathological pro cesses. However, reversible release of cTn in analogy to the marathon runners may also contribute to the elevated cTn levels in these patients (23).…”

Section: Pathophysiology Of Troponin Releasementioning

confidence: 99%

Diagnostic and Prognostic Information Provided by a High Sensitivity Assay for Cardiac Troponin T

Jarausch¹

2010

Journal of Medical Biochemistry

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Kratak sadr`aj: Sr~ani troponini (cTns) preporu~uju se kao biomarkeri za dijagnozu akutnog infarkta miokarda, pro cenu rizika i prognoze, kao i za odre|ivanje antitrombotske terapije i strategije revaskularizacije kod pacijenata sa akutnim koronarnim sindromima. Implementacija visoko osetljivih testova za cTn u klini~koj praksi je pove}ala broj pacijenata kod kojih je dijagnostikovan infarkt miokarda. Pored toga, pove}an je i broj pacijenata sa povi{e -nim nivo ima cTn koji se ne mogu pripisati akutnom ishemijskom o{te }enju, {to je prime}eno kod pacijenata sa hro ni~nim sr~anim bolestima i drugim neishemijskim sr~a -nim o{te}e njima ili kod pacijenata sa o{te}enom renalnom funkcijom. Nova definicija infarkta miokarda podr`ava tuma ~enje povi{enih cTn izmerenih pomo}u visokoosetljivih testova za cTn kod pacijenata kod kojih se sumnja na akutni koro narni sindrom. Ovde se prikazuju kli ni~ke studije sa nedavno uvedenim visokoosetljivim testom za cTnT (TnT hs) uz uop{teni osvrt na iskustva sa viso ko osetljivim cTn testovima.Klju~ne re~i: sr~ani troponin, visokoosetljivi test za sr~ani troponin, akutni infarkt miokarda

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Use of Cardiac Biomarkers in End-Stage Renal Disease

Cited by 183 publications

References 94 publications

Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals: The D:A:D Study

Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals: The D:A:D Study

Left Ventricular Mass in Chronic Kidney Disease and ESRD

Diagnostic and Prognostic Information Provided by a High Sensitivity Assay for Cardiac Troponin T

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