ST2 as a novel prognostic marker in end-stage renal disease patients on hemodiafiltration

Abstract

BackgroundPatients with end-stage renal disease (ESRD) are prone to severe heart failure (HF) and to several life-threatening events. Therefore, the ability to assess disease prognosis and the risk of short-term events or death is of great importance. The role of soluble ST2 (sST2) as a potential new prognostic marker in ESRD patients is not yet known. The aim of our study was to assess the prognostic value of sST2 in ESRD patients on hemodiafiltration (HDF) and compare it with NT-proBNP, an established prognostic marker for HF and renal disease. Methods123 ESRD patients on HDF were prospectively followed up from the date of the sST2/NT-proBNP measurement until their death or maximally up to 829days. Patients were divided into a low sST2 group (<35ng/mL) or a high sST2 group (≥35ng/mL) according to their measured sST2 concentration at the start of the study. Kaplan-Meier survival curves, Cox regression model and ROC analyses were used in statistical analysis. ResultsDuring follow-up 32 (26.0%) patients died (all cause mortality). Median (IQR) sST2 serum concentrations of survivors and deceased were 26 (24–29) and 36 (28–59) ng/mL, respectively. The Kaplan-Meier survival analysis showed that survival rate of the high sST2 group was statistically significant lower than of the low sST2 group (P<0.01). Cox regression model for sST2, using a dichotomized (cut-off=35ng/mL, hazard ratio (HR) (95%CI)=2.72 (1.50–4.90), P=0.001) and continuous approach with log-transformed values in univariate (HR (95%CI)=17.35 (4.84–62.22), P<0.001) and multivariate analysis (HR (95%CI)=7.19 (1.89–27.38), P=0.004) showed that sST2 alone and in combination with NT-proBNP can predict all cause mortality. ConclusionssST2 has confirmed prognostic value and is independent of renal function and of HDF treatment. It could be useful independent prognostic marker for stratifying ESRD patients on HDF at high risk for life-threatening events, hospitalisation and death, especially in combination with NT-proBNP.