TY - JOUR
T1 - Upper Reference Limits for High-Sensitivity Cardiac Troponin T and N-Terminal Fragment of the Prohormone Brain Natriuretic Peptide in Patients With CKD
AU - CRIC Study Investigators
AU - Bansal, Nisha
AU - Zelnick, Leila R.
AU - Ballantyne, Christie M.
AU - Chaves, Paulo H.M.
AU - Christenson, Robert H.
AU - Coresh, Josef
AU - deFilippi, Christopher R.
AU - de Lemos, James A.
AU - Daniels, Lori B.
AU - Go, Alan S.
AU - He, Jiang
AU - Hedayati, S. Susan
AU - Matsushita, Kunihiro
AU - Nambi, Vijay
AU - Shlipak, Michael G.
AU - Taliercio, Jonathan J.
AU - Seliger, Stephen L.
AU - Appel, Lawrence J.
AU - Feldman, Harold I.
AU - Lash, James P.
AU - Nelson, Robert G.
AU - Rao, Panduranga S.
AU - Rahman, Mahboob
AU - Shah, Vallabh O.
AU - Townsend, Raymond R.
AU - Unruh, Mark L.
N1 - Publisher Copyright:
© 2021 National Kidney Foundation, Inc.
PY - 2022/3
Y1 - 2022/3
N2 - Rationale & Objective: The utility of conventional upper reference limits (URL) for N-terminal pro–brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hsTnT) in chronic kidney disease (CKD) remains debated. We analyzed the distribution of hsTnT and NT-proBNP in people with CKD in ambulatory settings to examine the diagnostic value of conventional URL in this population. Study Design: Observational study. Setting & Participants: We studied participants of the Chronic Renal Insufficiency Cohort (CRIC) with CKD and no self-reported history of cardiovascular disease. Exposure: Estimated glomerular filtration rate (eGFR). Outcome: NT-proBNP and hsTnT at baseline. Analytical Approach: We described the proportion of participants above the conventional URL for NT-proBNP (125 pg/mL) and hsTnT (14 ng/L) overall and by eGFR. We then estimated 99th percentile URL for NT-proBNP and hsTnT. Using quantile regression of the 99th percentile, we modeled the association of eGFR with NT-proBNP and hsTnT. Results: Among 2,312 CKD participants, 40% and 43% had levels of NT-proBNP and hsTnT above the conventional URL, respectively. In those with eGFR < 30 mL/min/1.73 m2, 71% and 68% of participants had concentrations of NT-proBNP and hsTnT above the conventional URL, respectively. Among all CKD participants, the 99th percentile for NT-proBNP was 3,592 (95% CI, 2,470-4,849) pg/mL and for hsTnT it was 126 (95% CI, 100-144) ng/L. Each 15 mL/min/1.73 m2 decrement in eGFR was associated with a ~40% higher threshold for the 99th percentile of NT-proBNP (1.43 [95% CI, 1.21-1.69]) and hsTnT (1.45 [95% CI, 1.31-1.60]). Limitations: Study included ambulatory patients, and we could not test the accuracy of the URL of NT-proBNP and hsTnT in the acute care setting. Conclusions: In this ambulatory CKD population with no self-reported history of cardiovascular disease, a range of 40%-88% of participants had concentrations of NT-proBNP and hsTnT above the conventional URL, depending on eGFR strata. Developing eGFR-specific thresholds for these commonly used cardiac biomarkers in the setting of CKD may improve their utility for evaluation of suspected heart failure and myocardial infarction.
AB - Rationale & Objective: The utility of conventional upper reference limits (URL) for N-terminal pro–brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hsTnT) in chronic kidney disease (CKD) remains debated. We analyzed the distribution of hsTnT and NT-proBNP in people with CKD in ambulatory settings to examine the diagnostic value of conventional URL in this population. Study Design: Observational study. Setting & Participants: We studied participants of the Chronic Renal Insufficiency Cohort (CRIC) with CKD and no self-reported history of cardiovascular disease. Exposure: Estimated glomerular filtration rate (eGFR). Outcome: NT-proBNP and hsTnT at baseline. Analytical Approach: We described the proportion of participants above the conventional URL for NT-proBNP (125 pg/mL) and hsTnT (14 ng/L) overall and by eGFR. We then estimated 99th percentile URL for NT-proBNP and hsTnT. Using quantile regression of the 99th percentile, we modeled the association of eGFR with NT-proBNP and hsTnT. Results: Among 2,312 CKD participants, 40% and 43% had levels of NT-proBNP and hsTnT above the conventional URL, respectively. In those with eGFR < 30 mL/min/1.73 m2, 71% and 68% of participants had concentrations of NT-proBNP and hsTnT above the conventional URL, respectively. Among all CKD participants, the 99th percentile for NT-proBNP was 3,592 (95% CI, 2,470-4,849) pg/mL and for hsTnT it was 126 (95% CI, 100-144) ng/L. Each 15 mL/min/1.73 m2 decrement in eGFR was associated with a ~40% higher threshold for the 99th percentile of NT-proBNP (1.43 [95% CI, 1.21-1.69]) and hsTnT (1.45 [95% CI, 1.31-1.60]). Limitations: Study included ambulatory patients, and we could not test the accuracy of the URL of NT-proBNP and hsTnT in the acute care setting. Conclusions: In this ambulatory CKD population with no self-reported history of cardiovascular disease, a range of 40%-88% of participants had concentrations of NT-proBNP and hsTnT above the conventional URL, depending on eGFR strata. Developing eGFR-specific thresholds for these commonly used cardiac biomarkers in the setting of CKD may improve their utility for evaluation of suspected heart failure and myocardial infarction.
KW - Cardiac biomarkers
KW - N-terminal pro–brain natriuretic peptide (NT-proBNP)
KW - cardiovascular disease
KW - chronic kidney disease (CKD)
KW - diagnostic threshold
KW - heart failure (HF)
KW - high-sensitivity cardiac troponin T (hsTnT)
KW - laboratory measurement
KW - myocardial infarction (MI)
KW - troponin
KW - upper limit of normal (ULN)
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U2 - 10.1053/j.ajkd.2021.06.017
DO - 10.1053/j.ajkd.2021.06.017
M3 - Article
C2 - 34293394
AN - SCOPUS:85114744170
SN - 0272-6386
VL - 79
SP - 383
EP - 392
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 3
ER -