4.7 Article

Cardiac and Stress Biomarkers and Chronic Kidney Disease Progression: The CRIC Study

Journal

CLINICAL CHEMISTRY
Volume 65, Issue 11, Pages 1448-1457

Publisher

OXFORD UNIV PRESS INC
DOI: 10.1373/clinchem.2019.305797

Keywords

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Funding

  1. NIDDK
  2. Roche Diagnostics
  3. Siemens Healthineers
  4. Beckman Coulter
  5. Quidel
  6. Abbott Diagnostics
  7. National Institute of Diabetes, Digestive and Kidney Diseases
  8. National Institute of Diabetes and Digestive and Kidney Diseases [U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, U01DK060902]
  9. Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science Award NIH/NCATS [UL1TR000003]
  10. Johns Hopkins University [UL1 TR-000424]
  11. University of Maryland GCRC [M01 RR-16500]
  12. Clinical and Translational Science Collaborative of Cleveland
  13. National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health [UL1TR000439]
  14. NIH roadmap for Medical Research
  15. Michigan Institute for Clinical and Health Research (MICHR) [UL1TR000433]
  16. University of Illinois at Chicago CTSA [UL1RR029879]
  17. Tulane COBRE for Clinical and Translational Research in Cardiometabolic Diseases [P20 GM109036]
  18. Kaiser Permanente NIH/NCRR UCSF-CTSI [UL1 RR-024131]
  19. [R01 DK103612]

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BACKGROUND: Increases in cardiac and stress biomarkers may be associated with loss of kidney function through shared mechanisms involving cardiac and kidney injury. We evaluated the associations of cardiac and stress biomarkers [N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hsTnT), growth differentiation factor 15 (GDF-15), soluble ST-2 (sST-2)] with progression of chronic kidney disease (CKD). METHODS: We included 3664 participants with CKD from the Chronic Renal Insufficiency Cohort study. All biomarkers were measured at entry. The primary outcome was CKD progression, defined as progression to end-stage renal disease (ESRD) or 50% decline in estimated glomerular filtration rate (eGFR). Cox models tested the association of each biomarker with CKD progression, adjusting for demographics, site, diabetes, cardiovascular disease, eGFR, urine proteinuria, blood pressure, body mass index, cholesterol, medication use, and mineral metabolism. RESULTS: There were 1221 participants who had CKD progression over a median (interquartile range) follow-up of 5.8 (2.4-8.6) years. GDF-15, but not sST2, was significantly associated with an increased risk of CKD progression [hazard ratios (HRs) are per SD increase in log-transformed biomarker] : GDF-15 (HR, 1.50; 95% CI, 1.35-1.67) and sST2 (HR, 1.07; 95% CI, 0.99-1.14). NT-proBNP and hsTnT were also associated with increased risk of CKD progression, but weaker than GDF- 15: NT-proBNP (HR, 1.24; 95% CI, 1.13-1.36) hsTnT (HR, 1.11; 95% CI, 1.01-1.22). CONCLUSIONS: Increases in GDF-15, NT-proBNP, and hsTnT are associated with greater risk for CKD progression. These biomarkers may inform mechanisms underlying kidney injury. (C) 2019 American Association for Clinical Chemistry

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