title: Creatine-kinase and dialysis patients, a helpful tool for stratifying cardiovascular risk?
abstract: OBJECTIVE
  Hemodialysis patients have an enhanced risk for cardiovascular events. Cardiac biomarkers provide useful information for stratifying their risk. However the prognosis value of creatine kinase MB isoenzyme (CKMB) has not yet been validated in this population. The aim of the present study is to determine the predictable value of CK-MB in hemodialysis.
  
  
  METHODS
  A cohort of 211 hemodialysis patients (58.3% male, median age 73 (60-80) years) were followed for 39 (19-56) months. Cardiac biomarkers including CKMB were recorded at baseline. Factors associated to CKMB and prognosis value of this biomarker was studied.
  
  
  RESULTS
  The median value of CKMB was 1 (1-2) ng/mL with no patient exceeding normal laboratory values. Previous heart disease, diabetes mellitus, peripheral vascular disease and systolic and diastolic dysfunction were associated with higher levels of CKMB. Ninety-four patients (44.5%) cardiovascular events were recorded. CKMB levels ≥2ng/mL was independently associated to cardiovascular events during the follow up after adjusting. Adding CKMB to a model including several variables for predicting cardiovascular events, resulted in 17% improvement in risk discrimination (IDI) with a relative IDI of 9.9% (p=0.04).
  
  
  CONCLUSIONS
  CKMB is a good marker for stratifying cardiovascular risk in hemodialysis patients and adds prognosis information to other well known independent predictors for cardiovascular events.
authors.affiliation: Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: borjaqg@gmail.com.
authors.forename: Borja
authors.initials: B
authors.lastname: Quiroga
authors.affiliation: Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Almudena
authors.initials: A
authors.lastname: Vega
authors.affiliation: Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Soraya
authors.initials: S
authors.lastname: Abad
authors.affiliation: Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Maite
authors.initials: M
authors.lastname: Villaverde
authors.affiliation: Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Reque
authors.affiliation: Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: López-Gómez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002318:Cardiovascular Diseases; D003401:Creatine; D052279:Creatine Kinase, MB Form / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D052279:Creatine Kinase, MB Form; D003401:Creatine
keywords: Biomarcadores cardiacos; CKMB; Cardiac biomarkers; Cardiovascular; Hemodialysis; Hemodiálisis