title: Association between cardiac biomarkers and the development of ESRD in patients with type 2 diabetes mellitus, anemia, and CKD.
abstract: BACKGROUND
  In patients with chronic kidney disease (CKD), as in other populations, elevations in cardiac biomarker levels predict increased risk of cardiovascular events. We examined the value of troponin T (TnT) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) in assessing the risk of developing end-stage renal disease (ESRD) in diabetic patients with CKD.
  
  
  METHODS
  Prospective cohort study nested within a randomized clinical trial.
  
  
  METHODS
  Patients with type 2 diabetes, CKD (estimated glomerular filtration rate [eGFR], 20-60 mL/min/1.73 m(2)), and anemia enrolled in TREAT (Trial to Reduce Cardiovascular Events With Aranesp Therapy).
  
  
  METHODS
  Serum levels of the cardiac biomarkers TnT and NT-pro-BNP.
  
  
  RESULTS
  Incidence of ESRD and the composite of death or ESRD.
  
  
  METHODS
  We measured TnT and NT-pro-BNP in baseline serum samples from the first 1,000 patients enrolled in TREAT. The relationship of these cardiac biomarker levels to the development of ESRD and death or ESRD was analyzed in multivariable regression models.
  
  
  RESULTS
  Detectable TnT (≥0.01 ng/mL) was present in 45% of participants, and median NT-pro-BNP level was elevated at 605 pg/mL. Higher levels of both cardiac biomarkers were associated independently with higher rates of ESRD, as well as death or ESRD, and remained prognostically important after adjustment for eGFR, proteinuria, and other known predictors of CKD progression. The addition of cardiac biomarkers to a multivariable model for prediction of ESRD improved discrimination of those with and without an event by 16.9% (95% CI, 6.3%-27.4%).
  
  
  CONCLUSIONS
  Observational study in a clinical trial cohort; results require validation.
  
  
  CONCLUSIONS
  In ambulatory patients with type 2 diabetes, anemia, and CKD, TnT and NT-pro-BNP levels frequently are elevated. These cardiac-derived biomarkers enhance prediction of ESRD beyond established risk factors. Measurement of TnT and NT-pro-BNP may improve the identification of patients with CKD who are likely to require renal replacement therapy, supporting a link between cardiac injury and the development of ESRD.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Akshay S
authors.initials: AS
authors.lastname: Desai
authors.forename: Robert
authors.initials: R
authors.lastname: Toto
authors.forename: Petr
authors.initials: P
authors.lastname: Jarolim
authors.forename: Hajime
authors.initials: H
authors.lastname: Uno
authors.forename: Kai-Uwe
authors.initials: KU
authors.lastname: Eckardt
authors.forename: Reshma
authors.initials: R
authors.lastname: Kewalramani
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.forename: Eldrin F
authors.initials: EF
authors.lastname: Lewis
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Parving
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood* / Q000150:complications*; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications*; D003928:Diabetic Nephropathies / Q000097:blood* / Q000150:complications*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000097:blood* / Q000150:complications*; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000209:etiology*; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D012307:Risk Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain