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Prognostic efficacy of cardiac biomarkers for mortality in dialysis patients

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Abstract:

Abstract Background:

The high prevalence of cardiovascular mortality in the end-stage renal disease population is well established. The aim of this current study was to document the relative prognostic significance of established cardiac biomarkers troponin T (TnT), troponin I (TnI), B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-pro-BNP) in this population. Methods:

A prospective cohort study of dialysis patients undertaken in a single tertiary centre in Australia. Relevant clinical and biochemical information was collected at entry and all patients followed up prospectively without any loss to follow up. End-point of interest was all-cause mortality. Statistical analysis using Cox proportional hazards was used to study relationship between competing covariates and outcome. A total of 143 patients with a mean age of 59.67 ± 15.49 years was followed up for a median duration of 30 months. Of these patients, 89.3% were white Australians of European ancestry. Twenty-seven per cent had an established diagnosis of diabetes mellitus. The mean concentrations (±SD) of TnT, TnI, BNP and N-terminal peptide pro-BNP (NT-pro-BNP) were 0.08 ± 0.04 µg/L, 0.09 ± 0.2 µg/L, 270 ± 117 ng/L and 1434 ± 591 ng/L respectively. Results:

Twenty-eight subjects died during the period of follow up. By univariate analysis, all cardiac markers (TnT, TnI, BNP, NT-pro-BNP and C-reactive protein) were significantly associated with an increase in mortality. On Cox proportionate hazards analysis, only albumin and NT-pro-BNP showed a significant association with mortality, with hazard ratios of 0.834, 95% confidence interval (CI) 0.779–0.893, P < 0.001, and 1.585, 95%CI 1.160–20165, P = 0.004 respectively. Conclusion:

In patients with end-stage renal failure on dialysis NT-pro-BNP provides greater prognostic information compared with TnT and TnI.

Keywords: BNP; NT-pro-BNP; dialysis; mortality; renal failure; troponin

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1445-5994.2009.01846.x

Affiliations: 1: Nephrology, The Canberra Hospital and Departments of 2: Cardiology and 3: Departments of Chemical Pathology,

Publication date: December 1, 2009

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