title: B-Type Natriuretic Peptide and Cardiac Troponin I Are Associated With Adverse Outcomes in Stable Kidney Transplant Recipients.
abstract: BACKGROUND
  Approximately 200 000 kidney transplant recipients are living in the United States; they are at increased risk for cardiovascular and other adverse outcomes. Biomarkers predicting these outcomes are needed. Using specimens collected during the Folic Acid for Vascular Outcome Reduction in Transplantation trial, we determined whether plasma levels of B-type natriuretic peptide (BNP) and cardiac troponin I are associated with adverse outcomes in stable kidney transplant recipients.
  
  
  METHODS
  Five hundred ten subjects were selected randomly from the 4110 Folic Acid for Vascular Outcome Reduction in Transplantation participants. This cohort was then enriched for all additional subjects with adverse outcomes (death, dialysis-dependent kidney failure (DDKF), and cardiovascular outcomes) for a total of 1131 participants studied. Quartiles of BNP and high-sensitivity cardiac troponin I (hs-cTnI) were included in adjusted models. Combinations of normal and elevated hs-cTnI (>26.2 ng/L) and BNP (>100 pg/mL) were also studied.
  
  
  RESULTS
  Median concentrations (interquartile ranges) were 5.6 (3.3-10.5) ng/L for hs-cTnI and 39 (15, 94) pg/mL for BNP. Hazard ratios for each adverse outcome were higher with higher quartiles of BNP after adjustment and remained statistically significant after adding hs-cTnI to the model. The highest quartile hazard ratio for DDKF was 2.47 (95% confidence interval [95% CI], 1.21-5.05). Simultaneous elevations of BNP and hs-cTnI over clinical cutoffs were strongly associated with adverse outcomes with hazard ratios 8.8 (95% CI, 3.4-23.1) for DDKF and 6.3 (95% CI, 2.7-15.0) for cardiovascular outcomes.
  
  
  CONCLUSIONS
  Higher BNP is associated with mortality and cardiovascular and kidney outcomes in stable kidney transplant recipients. Elevated BNP and hs-cTnI identify candidates for targeted risk reduction.
authors.affiliation: 1 Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 2 Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 3 Department of Biostatistics, University of North Carolina, Chapel Hill, NC. 4 Division of Nephrology, Rhode Island Hospital, Providence, RI. 5 National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD. 6 University of Iowa, Iowa City, IA. 7 US Department of Agriculture, Jean Mayer Human Nutrition Research Center on Aging, Boston, MA. 8 Tufts Medical Center, Boston, MA.
authors.forename: Petr
authors.initials: P
authors.lastname: Jarolim
authors.forename: Brian L
authors.initials: BL
authors.lastname: Claggett
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Conrad
authors.forename: Myra A
authors.initials: MA
authors.lastname: Carpenter
authors.forename: Anastasia
authors.initials: A
authors.lastname: Ivanova
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Bostom
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Hunsicker
authors.forename: Paul F
authors.initials: PF
authors.lastname: Jacques
authors.forename: Lisa
authors.initials: L
authors.lastname: Gravens-Mueller
authors.forename: Peter
authors.initials: P
authors.lastname: Finn
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Weiner
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D066027:Transplant Recipients; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020097:Natriuretic Peptide, Brain