Nontraditional cardiovascular biomarkers and estimation of cardiovascular risk in predialysis chronic kidney disease patients and their correlations with carotid intima media thickness.
BACKGROUND
Cardiovascular biomarkers such as N-terminal pro-B-type natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT), hs-CRP (high sensitivity C-reactive protein), and albuminuria predict underlying heart disease in the general population as well as CKD patients.


OBJECTIVE
We aimed to study the association of NT-proBNP, cTnT, hs-CRP, and spot urine albumin creatinine ratio with carotid intima media thickness (CIMT) for cardiovascular risk estimation in predialysis CKD (chronic kidney disease) patients.


METHODS
This cross-sectional study included a total of 120 adult predialysis CKD patients. Forty patients were allocated in each predialysis CKD group of stages 3, 4, and 5. Serum cTnT and hs-CRP, plasma NT-proBNP, and single spot urine albumin creatinine ratio (ACR) were measured. Ultrasonographic examination of carotid artery was done with 7.5 MHz linear probe in B mode ultrasonography and carotid intima media thickness was measured.


RESULTS
Mean values ± standard deviation of plasma NT-proBNP (pg/mL), serum hs-CRP (mg/L), spot urine ACR (mg/g of creatinine), and CIMT (mm) were 585.68 ± 514.84, 5.96 ± 2.52, 719.37 ± 411.36, and 0.78 ± 0.15, respectively in predialysis CKD patients (n = 120). Serum cTnT level was high in 40% of predialysis CKD patients. Among cardiovascular biomarkers, plasma NT-proBNP had maximum strength of correlation (Spearman Rho correlation coefficient; r = 0.575 and P < 0.0001) with the carotid intima media thickness followed by serum cTnT (Spearman Rho correlation coefficient; r = 0.419 and P < 0.0001), spot urine albumin creatinine ratio (Spearman Rho correlation coefficient; r = 0.322 and P < 0.0001), and serum hs-CRP (Spearman Rho correlation coefficient; r = 0.246 and P = 0.007).


CONCLUSIONS
Nontraditional cardiovascular biomarkers such as plasma NT-proBNP, serum cTnT, serum hs-CRP, and spot urine ACR significantly correlate with CIMT. These biomarkers can estimate the cardiovascular risk in a predialysis CKD population with expected high cardiac morbidity and mortality.
Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India.
Satyanand
S
Sathi
Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India.
Himanshu
H
Mahapatra
Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India.
Sham
S
Sunder
Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India.
Rajesh
R
Jayaraman
Department of Biochemistry, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India.
Neera
N
Sharma
Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India.
Himanshu
H
Verma
Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India.
Venkataramanan
V
Krishnamoorthy
Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India.
Anurag
A
Gupta
Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India.
Prabhu
P
Kanchi
Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India.
Sunil
S
Daksh
Department of Nephrology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India.
Lalit
L
Pursnani
Department of Radiology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India.
Faisal
F
Shadab
Department of Radiology, PGIMER and Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India.
Manveer
M
Singh
Carotid Intima Media Thickness; Non-Traditional Cardiovascular Biomarkers; Predialysis CKD Patients; Spot Urine Albumin Creatinine Ratio