title: NT-proBNP and troponin T and risk of rapid kidney function decline and incident CKD in elderly adults.
abstract: OBJECTIVE
  Elevations in N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T are associated with poor cardiovascular outcomes. Whether elevations in these cardiac biomarkers are associated with decline in kidney function was evaluated.
  
  
  METHODS
  N-terminal pro-B-type natriuretic peptide and troponin T were measured at baseline in 3752 participants free of heart failure in the Cardiovascular Health Study. eGFR was determined from the Chronic Kidney Disease Epidemiology Collaboration equation using serum cystatin C. Rapid decline in kidney function was defined as decline in serum cystatin C eGFR≥30%, and incident CKD was defined as the onset of serum cystatin C eGFR<60 among those without CKD at baseline (n=2786). Cox regression models were used to examine the associations of each biomarker with kidney function decline adjusting for demographics, baseline serum cystatin C eGFR, diabetes, and other CKD risk factors.
  
  
  RESULTS
  In total, 503 participants had rapid decline in serum cystatin C eGFR over a mean follow-up time of 6.41 (1.81) years, and 685 participants developed incident CKD over a mean follow-up time of 6.41 (1.74) years. Participants in the highest quartile of N-terminal pro-B-type natriuretic peptide (>237 pg/ml) had an 67% higher risk of rapid decline and 38% higher adjusted risk of incident CKD compared with participants in the lowest quartile (adjusted hazard ratio for serum cystatin C eGFR rapid decline, 1.67; 95% confidence interval, 1.25 to 2.23; hazard ratio for incident CKD, 1.38; 95% confidence interval, 1.08 to 1.76). Participants in the highest category of troponin T (>10.58 pg/ml) had 80% greater risk of rapid decline compared with participants in the lowest category (adjusted hazard ratio, 1.80; 95% confidence interval, 1.35 to 2.40). The association of troponin T with incident CKD was not statistically significant (hazard ratio, 1.17; 95% confidence interval, 0.92 to 1.50).
  
  
  CONCLUSIONS
  Elevated N-terminal pro-B-type natriuretic peptide and troponin T are associated with rapid decline of kidney function and incident CKD. Additional studies are needed to evaluate the mechanisms that may explain this association.
authors.affiliation: Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington; nbansal@nephrology.washington.edu.
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
authors.affiliation: Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington;
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.affiliation: Division of Nephrology, University of California, Davis, Sacramento, California;
authors.forename: Lorien
authors.initials: L
authors.lastname: Dalrymple
authors.affiliation: Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington;
authors.forename: Ian
authors.initials: I
authors.lastname: de Boer
authors.affiliation: Divisions of Cardiology and.
authors.forename: Christopher
authors.initials: C
authors.lastname: DeFilippi
authors.affiliation: Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington;
authors.forename: Bryan
authors.initials: B
authors.lastname: Kestenbaum
authors.affiliation: Division of Nephrology and.
authors.forename: Meyeon
authors.initials: M
authors.lastname: Park
authors.affiliation: Division of Nephrology, Tufts Medical Center, Boston, Massachusetts; and.
authors.forename: Mark
authors.initials: M
authors.lastname: Sarnak
authors.affiliation: Nephrology, University of Maryland, Baltimore, Maryland;
authors.forename: Stephen
authors.initials: S
authors.lastname: Seliger
authors.affiliation: Departments of Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, California; Division of General Internal Medicine, San Francisco Veterans Affair Medical Center, San Francisco, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Shlipak
mesh_terms: D000367:Age Factors; D000368:Aged; D000375:Aging; D015415:Biomarkers / Q000097:blood; D055316:Cystatin C / Q000097:blood; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000503:physiopathology*; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors; D020107:Troponin T / Q000097:blood*; D014481:United States / Q000453:epidemiology; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: CKD; epidemiology and outcomes; heart disease