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Change in Cardiac Biomarkers and Risk of Incident Heart Failure and Atrial Fibrillation in CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study.
Bansal, Nisha; Zelnick, Leila R; Soliman, Elsayed Z; Anderson, Amanda; Christenson, Robert; DeFilippi, Christopher; Deo, Rajat; Feldman, Harold I; He, Jiang; Ky, Bonnie; Kusek, John; Lash, James; Seliger, Stephen; Shafi, Tariq; Wolf, Myles; Go, Alan S; Shlipak, Michael G.
Afiliación
  • Bansal N; Kidney Research Institute, University of Washington, Seattle, WA. Electronic address: nbansal@nephrology.washington.edu.
  • Zelnick LR; Kidney Research Institute, University of Washington, Seattle, WA.
  • Soliman EZ; Kidney Research Institute, University of Washington, Seattle, WA.
  • Anderson A; Kidney Research Institute, University of Washington, Seattle, WA.
  • Christenson R; Kidney Research Institute, University of Washington, Seattle, WA.
  • DeFilippi C; Kidney Research Institute, University of Washington, Seattle, WA.
  • Deo R; Kidney Research Institute, University of Washington, Seattle, WA.
  • Feldman HI; Kidney Research Institute, University of Washington, Seattle, WA.
  • He J; Kidney Research Institute, University of Washington, Seattle, WA.
  • Ky B; Kidney Research Institute, University of Washington, Seattle, WA.
  • Kusek J; Kidney Research Institute, University of Washington, Seattle, WA.
  • Lash J; Kidney Research Institute, University of Washington, Seattle, WA.
  • Seliger S; Kidney Research Institute, University of Washington, Seattle, WA.
  • Shafi T; Kidney Research Institute, University of Washington, Seattle, WA.
  • Wolf M; Kidney Research Institute, University of Washington, Seattle, WA.
  • Go AS; Kidney Research Institute, University of Washington, Seattle, WA.
  • Shlipak MG; Kidney Research Institute, University of Washington, Seattle, WA.
Am J Kidney Dis ; 77(6): 907-919, 2021 06.
Article en En | MEDLINE | ID: mdl-33309861
RATIONALE & OBJECTIVE: Circulating cardiac biomarkers may signal potential mechanistic pathways involved in heart failure (HF) and atrial fibrillation (AF). Single measures of circulating cardiac biomarkers are strongly associated with incident HF and AF in chronic kidney disease (CKD). We tested the associations of longitudinal changes in the N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hsTnT), galectin-3, growth differentiation factor 15 (GDF-15), and soluble ST-2 (sST-2) with incident HF and AF in patients with CKD. STUDY DESIGN: Observational, case-cohort study design. SETTING & PARTICIPANTS: Adults with CKD enrolled in the Chronic Renal Insufficiency Cohort study. EXPOSURES: Biomarkers were measured at baseline and 2 years later among those without kidney failure. We created 3 categories of absolute change in each biomarker: the lowest quartile, the middle 2 quartiles, and the top quartile. OUTCOMES: The primary outcomes were incident HF and AF. ANALYTICAL APPROACH: Cox proportional hazards regression models were used to test the associations of the change categories of each cardiac biomarker with each outcome (with the middle 2 quartiles of change as the referent group), adjusting for potential confounders and baseline concentrations of each biomarker. RESULTS: The incident HF analysis included 789 participants (which included 138 incident HF cases), and the incident AF analysis included 774 participants (123 incident AF cases). In multivariable models, the top quartile of NT-proBNP change (>232pg/mL over 2years) was associated with increased risk of incident HF (HR, 1.79 [95% CI, 1.06-3.04]) and AF (HR, 2.32 [95% CI, 1.37-3.93]) compared with the referent group. Participants in the top quartile of sST2 change (>3.37ng/mL over 2years) had significantly greater risk of incident HF (HR, 1.89 [95% CI, 1.13-3.16]), whereas those in the bottom quartile (≤-3.78ng/mL over 2years) had greater risk of incident AF (HR, 2.43 [95% CI, 1.39-4.22]) compared with the 2 middle quartiles. There was no association of changes in hsTnT, galectin-3, or GDF-15 with incident HF or AF. LIMITATIONS: Observational study. CONCLUSIONS: In CKD, increases in NT-proBNP were significantly associated with greater risk of incident HF and AF, and increases in sST2 were associated with HF. Further studies should investigate whether these markers of subclinical cardiovascular disease can be modified to reduce the risk of cardiovascular disease in CKD.
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Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Fibrilación Atrial / Insuficiencia Renal Crónica / Insuficiencia Cardíaca Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Am J Kidney Dis Año: 2021 Tipo del documento: Article

Texto completo: 1 Bases de datos: MEDLINE Asunto principal: Fibrilación Atrial / Insuficiencia Renal Crónica / Insuficiencia Cardíaca Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Am J Kidney Dis Año: 2021 Tipo del documento: Article