B type natriuretic peptide and troponin T as independent predictors of cardiovascular mortality in predialysis patients with chronic kidney disease

Abstract

The use of cardiac biomarkers in prognostic purposes has been widely studied in the general population and the population of hemodialysis patients but not in patients with early-stage chronic kidney disease (peptide (BNP), N-terminal fragment of BNP (NTproBNP-a), troponin T (TnT), troponin I (TnI) CKD). The aim of this study was to determine the prognostic value of cardiac biomarkers [B-type natriuretic and highly sensitive C-reactive protein (hsCRP -a)] for cardiovascular mortality in asymptomatic predialysis CKD patients, stage IV and V. The study included 61 CKD patients (34 M, average age 62.6 ± 13.6 years, GFR 15.8±5.7 ml/min). All subjects underwent clinical evaluation, laboratory testing, echocardiographic examination and carotid artery ultrasound examination of the carotid arteries. During the period of follow-up (median 28 months), there were 18 deaths of which 9 were cardiovascular in origin. In a multivariate Cox regression analysis, BNP (p = 0.004), aortic calcification (p = 0.005), the TnT (0.018) and serum urea (p = 0.046) showed the independent predictive value for cardiovascular mortality. The optimal cut-off value of BNP for predicting _ cardiovascular mortality rate was 220.8 pg/ml. with a sensitivity of 85.7% and specificity of 78% (AUC = 0.831; p = 0.005) while the TnT cut off value of 0.05 ng / ml was also found to be significant with a sensitivity of 77.8% and a specificity of 78.8% (AUC = 0.798; p = 0.005). In stratified analysis, Kaplan-Meier curves showed _statistically significant differences in cardiovascular survival in patients with different levels of BNP (p = 0.024), TnT (p = 0.001) and NTproBNP (p = 0.033). As independent predictors of cardiovascular mortality, BNP and TnT can be used to stratify CV risk in asymptomatic patients with advanced HBS who have not started dialysis treatments yet.