title: Mortality prediction using modern peptide biomarkers in hemodialysis patients--a comparative analysis.
abstract: OBJECTIVE
  Determination of peptide biomarkers such as troponins, natriuretic peptides or the recently reported FGF23 can be useful to identify hemodialysis patients with a high risk of mortality. However, it is desirable to focus on few robust parameters to warrant their routine application.
  
  
  METHODS
  In a prospective cohort study with 239 prevalent hemodialysis patients we studied the prognostic significance of 10 simultaneously determined modern peptide biomarkers (high sensitive troponin I and T, NT-pro-BNP, BNP, MR-pro-ANP, MR-pro-ADM, CT-pro-ET1, copeptin, FGF23 and a-Klotho) and compared them with parameters traditionally associated with mortality (PTH, Ca, Pi, albumin, CRP, cholesterol, AP).
  
  
  RESULTS
  After a follow-up of 4 years, plasma concentration of troponins, natriuretic peptides, MR-pro-ADM, FGF23 as well as PTH, CRP, AP were significantly higher in deceased patients (n=95). Hazard ratios from cox regression on a continuous scale (doubling of plasma concentration) or relative in tertiles were highest for high sensitive troponins, followed by natriuretic peptides and MR-pro-ADM (1.6-2.0 and 2.3-5.5, resp.). C-indices were also highest for troponins (0.708-0.746), followed by natriuretic peptides (0.706-0.731). Traditional parameters had low c-indices (0.598-0.655). Stepwise cox regression revealed that among all parameters troponin I, NT-pro-BNP, PTH and CRP remained independent predictors of mortality and a composite score had the highest c-index (0.799 [0.740-0.849]).
  
  
  CONCLUSIONS
  Among peptide biomarkers high sensitive troponins and to a lesser extent natriuretic peptides are strong predictors of mortality in asymptomatic hemodialysis patients, followed by markers of mineral-bone disease and inflammation.
authors.affiliation: Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University of Tübingen, Germany.
authors.forename: Ferruh
authors.initials: F
authors.lastname: Artunc
authors.forename: Albina
authors.initials: A
authors.lastname: Nowak
authors.forename: Christian
authors.initials: C
authors.lastname: Müller
authors.forename: Andreas
authors.initials: A
authors.lastname: Peter
authors.forename: Nils
authors.initials: N
authors.lastname: Heyne
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Häring
authors.forename: Björn
authors.initials: B
authors.lastname: Friedrich
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D000089703:Fibroblast Growth Factor-23; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis; D015203:Reproducibility of Results
chemical_list: D015415:Biomarkers; C000717427:FGF23 protein, human; D010455:Peptides; D000089703:Fibroblast Growth Factor-23