TY - JOUR
T1 - Association between cardiac biomarkers and the development of ESRD in patients with type 2 diabetes mellitus, anemia, and CKD
AU - Desai, Akshay S.
AU - Toto, Robert
AU - Jarolim, Petr
AU - Uno, Hajime
AU - Eckardt, Kai Uwe
AU - Kewalramani, Reshma
AU - Levey, Andrew S.
AU - Lewis, Eldrin F.
AU - McMurray, John J V
AU - Parving, Hans Henrik
AU - Solomon, Scott D.
AU - Pfeffer, Marc A.
N1 - Funding Information:
Financial Disclosure: Dr Desai reports receiving consulting fees from Intel, Novartis, and Relypsa and grant support from AtCor Medical Inc ; Dr Toto, consulting fees from Takeda and Daiichi-Sankyo, grant support from Reata and Novartis , and serving as an advisory board member for Boehringer-Ingelheim; Dr Eckardt, consulting fees from Roche, Ortho Biotech, Glaxo Smith Kline, Stada, Hexal, and Johnson and Johnson, grant support from Roche , and lecture fees from Roche and Genzyme; Dr Lewis, grant support from Sanofi-Aventis ; Dr Parving, consulting fees from Novartis and lecture fees from Novartis; Dr Pfeffer, consulting fees from Affectis, Anthera, AstraZeneca, Biogen, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Centocor, CVRX, Cytokinetics, Daiichi-Sankyo, Genentech, Genzyme, Gilead, Glaxo Smith Kline, Medtronic, NicOx, Novartis, Roche, Salutria, Sanofi-Aventis, Servier, Via, University of Oxford, Amylin, and Mirabila, grant support from Baxter , Celladon , Novartis , and Sanofi-Aventis , and being named as a co-inventor on patents with Novartis and Boehringer Ingelheim.
Funding Information:
Support: TREAT was sponsored by Amgen. The concept for this manuscript was generated independently by the academic leadership. Cardiac biomarker assays and data analysis were performed at Brigham and Women's Hospital. Dr Toto reports receiving consulting fees, lecture fees, and support for travel to meetings from Amgen, as well as serving as an advisory board member for Amgen; Dr Jarolim, receiving grant support from Amgen ; Dr Eckardt, receiving consulting fees, lecture fees, support for travel to meetings, and grant support from Amgen ; Dr Kewalramani, being an employee of and owning stock in Amgen; Dr Levey, receiving grant support and support for travel to meetings from Amgen ; Dr Lewis, receiving consulting fees from Amgen; Dr McMurray, receiving grant support and support for travel to meetings from Amgen ; Dr Parving, receiving consulting fees from Amgen; Dr Solomon, receiving grant support from Amgen ; and Dr Pfeffer, receiving consulting fees, grant support, and support for travel to meetings from Amgen .
PY - 2011/11
Y1 - 2011/11
N2 - Background: In patients with chronic kidney disease (CKD), as in other populations, elevations in cardiac biomarker levels predict increased risk of cardiovascular events. We examined the value of troponin T (TnT) and N-terminal probrain natriuretic peptide (NT-pro-BNP) in assessing the risk of developing end-stage renal disease (ESRD) in diabetic patients with CKD. Study Design: Prospective cohort study nested within a randomized clinical trial. Setting & Participants: Patients with type 2 diabetes, CKD (estimated glomerular filtration rate [eGFR], 20-60 mL/min/1.73 m 2), and anemia enrolled in TREAT (Trial to Reduce Cardiovascular Events With Aranesp Therapy). Predictors: Serum levels of the cardiac biomarkers TnT and NT-pro-BNP. Outcomes: Incidence of ESRD and the composite of death or ESRD. Measurements: We measured TnT and NT-pro-BNP in baseline serum samples from the first 1,000 patients enrolled in TREAT. The relationship of these cardiac biomarker levels to the development of ESRD and death or ESRD was analyzed in multivariable regression models. Results: Detectable TnT (<0.01 ng/mL) was present in 45% of participants, and median NT-pro-BNP level was elevated at 605 pg/mL. Higher levels of both cardiac biomarkers were associated independently with higher rates of ESRD, as well as death or ESRD, and remained prognostically important after adjustment for eGFR, proteinuria, and other known predictors of CKD progression. The addition of cardiac biomarkers to a multivariable model for prediction of ESRD improved discrimination of those with and without an event by 16.9% (95% CI, 6.3%-27.4%). Limitations: Observational study in a clinical trial cohort; results require validation. Conclusions: In ambulatory patients with type 2 diabetes, anemia, and CKD, TnT and NT-pro-BNP levels frequently are elevated. These cardiac-derived biomarkers enhance prediction of ESRD beyond established risk factors. Measurement of TnT and NT-pro-BNP may improve the identification of patients with CKD who are likely to require renal replacement therapy, supporting a link between cardiac injury and the development of ESRD.
AB - Background: In patients with chronic kidney disease (CKD), as in other populations, elevations in cardiac biomarker levels predict increased risk of cardiovascular events. We examined the value of troponin T (TnT) and N-terminal probrain natriuretic peptide (NT-pro-BNP) in assessing the risk of developing end-stage renal disease (ESRD) in diabetic patients with CKD. Study Design: Prospective cohort study nested within a randomized clinical trial. Setting & Participants: Patients with type 2 diabetes, CKD (estimated glomerular filtration rate [eGFR], 20-60 mL/min/1.73 m 2), and anemia enrolled in TREAT (Trial to Reduce Cardiovascular Events With Aranesp Therapy). Predictors: Serum levels of the cardiac biomarkers TnT and NT-pro-BNP. Outcomes: Incidence of ESRD and the composite of death or ESRD. Measurements: We measured TnT and NT-pro-BNP in baseline serum samples from the first 1,000 patients enrolled in TREAT. The relationship of these cardiac biomarker levels to the development of ESRD and death or ESRD was analyzed in multivariable regression models. Results: Detectable TnT (<0.01 ng/mL) was present in 45% of participants, and median NT-pro-BNP level was elevated at 605 pg/mL. Higher levels of both cardiac biomarkers were associated independently with higher rates of ESRD, as well as death or ESRD, and remained prognostically important after adjustment for eGFR, proteinuria, and other known predictors of CKD progression. The addition of cardiac biomarkers to a multivariable model for prediction of ESRD improved discrimination of those with and without an event by 16.9% (95% CI, 6.3%-27.4%). Limitations: Observational study in a clinical trial cohort; results require validation. Conclusions: In ambulatory patients with type 2 diabetes, anemia, and CKD, TnT and NT-pro-BNP levels frequently are elevated. These cardiac-derived biomarkers enhance prediction of ESRD beyond established risk factors. Measurement of TnT and NT-pro-BNP may improve the identification of patients with CKD who are likely to require renal replacement therapy, supporting a link between cardiac injury and the development of ESRD.
KW - Chronic kidney disease
KW - biomarker
KW - diabetes
KW - end-stage renal disease
KW - natriuretic peptides
KW - troponin
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U2 - 10.1053/j.ajkd.2011.05.020
DO - 10.1053/j.ajkd.2011.05.020
M3 - Article
C2 - 21820220
AN - SCOPUS:80055023975
VL - 58
SP - 717
EP - 728
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
SN - 0272-6386
IS - 5
ER -