title: High-sensitivity troponin T and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and risk of incident heart failure in patients with CKD: the Chronic Renal Insufficiency Cohort (CRIC) Study.
abstract: High-sensitivity troponin T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) strongly predict heart failure (HF) in the general population. However, the interpretation of levels of these biomarkers as predictors of HF is uncertain among patients with CKD. Here, we investigated whether hsTnT and NT-proBNP are associated with incident HF among patients with CKD. In a prospective cohort analysis, we studied 3483 people with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study recruited from June of 2003 to August of 2008 who were free of HF at baseline. We used Cox regression to examine the association of baseline levels of hsTnT and NT-proBNP with incident HF after adjustment for demographic factors, traditional cardiovascular risk factors, markers of kidney disease, pertinent medication use, and mineral metabolism markers. At baseline, hsTnT levels ranged from ≤5.0 to 738.7 pg/ml, and NT-proBNP levels ranged from ≤5 to 35,000 pg/ml. Compared with those who had undetectable hsTnT, participants in the highest quartile (>26.5 pg/ml) had a significantly higher rate of HF (hazard ratio, 4.77; 95% confidence interval, 2.49 to 9.14). Similarly, compared with those in the lowest NT-proBNP quintile (<47.6 pg/ml), participants in the highest quintile (>433.0 pg/ml) experienced a substantially higher rate of HF (hazard ratio, 9.57; 95% confidence interval, 4.40 to 20.83) [corrected]. In conclusion, hsTnT and NT-proBNP were strongly associated with incident HF among a diverse cohort of individuals with mild to severe CKD. Elevations in these biomarkers may indicate subclinical changes in volume and myocardial stress that subsequently contribute to clinical HF.
authors.affiliation: University of Washington, Seattle, Washington; nbansal@nephrology.washington.edu.
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Amanda
authors.initials: A
authors.lastname: Hyre Anderson
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.affiliation: University of Maryland, School of Medicine, Baltimore, Maryland;
authors.forename: Robert H
authors.initials: RH
authors.lastname: Christenson
authors.affiliation: University of Maryland, School of Medicine, Baltimore, Maryland;
authors.forename: Christopher R
authors.initials: CR
authors.lastname: deFilippi
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Rajat
authors.initials: R
authors.lastname: Deo
authors.affiliation: Yale University, New Haven, Connecticut;
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Dries
authors.affiliation: Kaiser Permanente Northern California, Oakland, California;
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.affiliation: Tulane University, New Orleans, Louisiana;
authors.forename: Jiang
authors.initials: J
authors.lastname: He
authors.affiliation: National Institutes of Health, Bethesda, Maryland;
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.affiliation: University of Illinois, Chicago, Illinois;
authors.forename: James P
authors.initials: JP
authors.lastname: Lash
authors.affiliation: The George Washington University, Washington, DC;
authors.forename: Dominic
authors.initials: D
authors.lastname: Raj
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Sylvia
authors.initials: S
authors.lastname: Rosas
authors.affiliation: Northwestern University, Feinberg School of Medicine, Chicago, Illinois; and.
authors.forename: Myles
authors.initials: M
authors.lastname: Wolf
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Zhang
authors.affiliation: University of California, San Francisco, California.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Harold I
authors.initials: HI
authors.lastname: Feldman
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications*; 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
keywords: cardiovascular disease; heart failure; kidney disease