Utility of traditional circulating and imaging-based cardiac biomarkers in patients with predialysis CKD

Gates Colbert, Nishank Jain, James A de Lemos, S. Susan Hedayati

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Cardiac biomarkers, such as cardiac troponin T (cTnT), brain natriuretic peptide (BNP), and N-terminal-pro-BNP (NT-pro-BNP), are commonly used to diagnose acute coronary syndrome and congestive heart failure exacerbation in symptomatic patients. Levels of these biomarkers are frequently chronically elevated in asymptomatic patients with ESRD who are receiving maintenance dialysis. Other imaging biomarkers commonly encountered in nephrologists’ clinical practice, such as coronary artery calcium measured by computed tomography, left ventricular hypertrophy, and carotid intima-media thickness, are also frequently abnormal in asymptomatic patients with ESRD. This article critically reviews the limited observational data on associations between cTnT, BNP, NT-pro-BNP, coronary artery calcium, left ventricular hypertrophy, and carotid intimamedia thickness with cardiovascular events and death in non–dialysis-dependent patients with CKD. Although sufficient evidence suggests that these biomarkers may be used for prognostication, the diagnostic utility of cTnT, BNP, andNT-pro-BNP remain challenging in patientswith CKD.Decreased renal clearancemay affect the plasma levels of these biomarkers, and upper reference limits were originally derived in patients without CKD. Until better data are available, higher cutoffs, or a rise in level compared with previous values, have been proposed to help distinguish acute myocardial infarction from chronic elevations of cTnT in symptomatic patients with CKD. Additionally, it is not known whether these biomarkers are modifiable and amenable to interventions that could change hard clinical outcomes in patients with CKD not yet undergoing long-term dialysis.

Original languageEnglish (US)
Pages (from-to)515-529
Number of pages15
JournalClinical Journal of the American Society of Nephrology
Volume10
Issue number3
DOIs
StatePublished - 2015

Fingerprint

Brain Natriuretic Peptide
Biomarkers
Troponin T
Left Ventricular Hypertrophy
Chronic Kidney Failure
Dialysis
Coronary Vessels
Calcium
Carotid Intima-Media Thickness
Acute Coronary Syndrome
Heart Failure
Myocardial Infarction
Tomography
Maintenance
Kidney

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Utility of traditional circulating and imaging-based cardiac biomarkers in patients with predialysis CKD. / Colbert, Gates; Jain, Nishank; de Lemos, James A; Susan Hedayati, S.

In: Clinical Journal of the American Society of Nephrology, Vol. 10, No. 3, 2015, p. 515-529.

Research output: Contribution to journalArticle

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