title: NT-proBNP: is it a more significant risk factor for mortality than troponin T in incident hemodialysis patients?
abstract: Numerous studies have demonstrated that cardiac biomarkers are significant predictors of cardiovascular (CV) and all-cause mortality in ESRD patients, but most of the studies were retrospective or included small numbers of patients, only prevalent dialysis patients, or measured 1 or 2 biomarkers. This study was to analyze the association between 3 cardiac biomarkers and mortality in incident HD patients. A prospective cohort of 864 incident HD patients was followed for 30 months. Based on the median values of baseline NT-proBNP, cTnT, and hsCRP, the patients were divided into "high" and "low" groups, and CV and all-cause mortality were compared between each group. Additionally, time-dependent ROC curves were constructed, and the NRI and IDI of the models with various biomarkers were calculated. The CV survival rates were significantly lower in the "high" NT-proBNP and cTnT groups compared to the corresponding "low" groups, while there was no significant difference in CV survival rate between the 2 hsCRP groups. However, all-cause mortality rates were significantly higher in all 3 "high" groups compared to each lower group. In multivariate analyses, only Ln NT-proBNP was found to be an independent predictor of mortality. Moreover, NT-proBNP was a more prognostic marker for mortality compared to cTnT. In conclusion, NT-proBNP is the biomarker that results in the most added prognostic value on top of traditional risk factors for CV and all-cause mortality in incident HD patients.
authors.affiliation: From the Department of Internal Medicine, College of Medicine, Brain Korea 21 for Medical Science, Severance Biomedical Science Institute, Yonsei University, Seoul, Korea (HJO, MJL, JTP, SHH, T-HY, S-WK); Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea (Y-LK); Department of Internal Medicine, Seoul National University of Medicine, Seoul, Korea (YSK); Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, Seoul, Korea (CWY); Department of Medicine, Chonnam National University Medical School, Gwangju, Korea (N-HK); and Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea (HSL).
authors.forename: Hyung Jung
authors.initials: HJ
authors.lastname: Oh
authors.forename: Mi Jung
authors.initials: MJ
authors.lastname: Lee
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Lee
authors.forename: Jung Tak
authors.initials: JT
authors.lastname: Park
authors.forename: Seung Hyeok
authors.initials: SH
authors.lastname: Han
authors.forename: Tae-Hyun
authors.initials: TH
authors.lastname: Yoo
authors.forename: Yong-Lim
authors.initials: YL
authors.lastname: Kim
authors.forename: Yon Su
authors.initials: YS
authors.lastname: Kim
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
authors.forename: Nam-Ho
authors.initials: NH
authors.lastname: Kim
authors.forename: Shin-Wook
authors.initials: SW
authors.lastname: Kang
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000150:complications / Q000401:mortality; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D006435:Renal Dialysis; D056910:Republic of Korea / Q000453:epidemiology; 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