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Change in Cardiac Biomarkers and Risk of Incident Heart Failure and Atrial Fibrillation in CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study
- Source :
- Am J Kidney Dis
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Rationale & Objective Circulating cardiac biomarkers may signal potential mechanistic pathways involved in heart failure (HF) and atrial fibrillation (AF). Single measures of circulating cardiac biomarkers are strongly associated with incident HF and AF in chronic kidney disease (CKD). We tested the associations of longitudinal changes in the N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hsTnT), galectin-3, growth differentiation factor 15 (GDF-15), and soluble ST-2 (sST-2) with incident HF and AF in patients with CKD. Study Design Observational, case-cohort study design. Setting & Participants Adults with CKD enrolled in the Chronic Renal Insufficiency Cohort study. Exposures Biomarkers were measured at baseline and 2 years later among those without kidney failure. We created 3 categories of absolute change in each biomarker: the lowest quartile, the middle 2 quartiles, and the top quartile. Outcomes The primary outcomes were incident HF and AF. Analytical Approach Cox proportional hazards regression models were used to test the associations of the change categories of each cardiac biomarker with each outcome (with the middle 2 quartiles of change as the referent group), adjusting for potential confounders and baseline concentrations of each biomarker. Results The incident HF analysis included 789 participants (which included 138 incident HF cases), and the incident AF analysis included 774 participants (123 incident AF cases). In multivariable models, the top quartile of NT-proBNP change (>232 pg/mL over 2 years) was associated with increased risk of incident HF (HR, 1.79 [95% CI, 1.06-3.04]) and AF (HR, 2.32 [95% CI, 1.37-3.93]) compared with the referent group. Participants in the top quartile of sST2 change (>3.37 ng/mL over 2 years) had significantly greater risk of incident HF (HR, 1.89 [95% CI, 1.13-3.16]), whereas those in the bottom quartile (≤−3.78 ng/mL over 2 years) had greater risk of incident AF (HR, 2.43 [95% CI, 1.39-4.22]) compared with the 2 middle quartiles. There was no association of changes in hsTnT, galectin-3, or GDF-15 with incident HF or AF. Limitations Observational study. Conclusions In CKD, increases in NT-proBNP were significantly associated with greater risk of incident HF and AF, and increases in sST2 were associated with HF. Further studies should investigate whether these markers of subclinical cardiovascular disease can be modified to reduce the risk of cardiovascular disease in CKD.
- Subjects :
- Male
medicine.medical_specialty
030232 urology & nephrology
Article
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Internal medicine
Atrial Fibrillation
Humans
Medicine
Prospective Studies
030212 general & internal medicine
Renal Insufficiency, Chronic
Aged
Heart Failure
business.industry
Atrial fibrillation
Middle Aged
Brain natriuretic peptide
medicine.disease
Quartile
Nephrology
Heart failure
Cohort
Cardiology
Biomarker (medicine)
Female
business
Biomarkers
Cohort study
Kidney disease
Subjects
Details
- ISSN :
- 02726386
- Volume :
- 77
- Database :
- OpenAIRE
- Journal :
- American Journal of Kidney Diseases
- Accession number :
- edsair.doi.dedup.....7e7b4d75a20106ed27d987b478a1505e