Association Between Cardiac Biomarkers and the Development of ESRD in Patients With Type 2 Diabetes Mellitus, Anemia, and CKD
Association Between Cardiac Biomarkers and the Development of ESRD in Patients With Type 2 Diabetes Mellitus, Anemia, and CKD
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DOI：
10.1053/j.ajkd.2011.05.020
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发表时间：
2011-11-01
影响因子：
13.2
通讯作者：
Pfeffer, Marc A.
中科院分区：
文献类型：
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作者：
Desai, Akshay S.;Toto, Robert;Pfeffer, Marc A.
背景：在慢性肾脏疾病(CKD)患者中，与其他人群一样，心脏生物标志物水平的升高预示着心血管事件风险的增加。我们检测了肌钙蛋白T(TNT)和N-末端脑利钠肽原(NT-PRO-BNP)在评估合并CKD的糖尿病患者发生终末期肾病(ESRD)风险中的价值。研究设计：嵌套在随机临床试验中的前瞻性队列研究。地点和对象：2型糖尿病、CKD患者(估计肾小球滤过率[EGFR]，20-60毫升/分钟/1.73米(2))，预测因素：血清心脏生物标志物TNT和NT-PRO-BNP水平。结果：ESRD的发生率和死亡或ESRD的组合。测量：我们测量了参加治疗的前1,000名患者的基线血清样本中的TNT和NT-PRO-BNP。结果：45%的受试者存在可检测到的TNT(>；=0.01 ng/m L)，中位数NT-proBNP水平升高至605pg/m L。这两种心脏生物标志物水平较高与终末期肾病、死亡或终末期肾病的发生率独立相关，在调整了EGFR、蛋白尿和其他已知的CKD进展预测因素后，仍具有重要的预后意义。将心脏生物标记物添加到预测终末期肾病的多变量模型中，可提高16.9%(95%可信区间，6.3%-27.4%)有无事件的区分。限制：临床试验队列中的观察性研究；结果需要验证。结论：在有2型糖尿病、贫血和慢性肾脏病的门诊患者中，TNT和NT-PRO-BNP水平经常升高。这些心脏衍生的生物标记物提高了对ESRD的预测能力，超越了已有的危险因素。测定TNT和NT-PRO-BNP可提高对可能需要肾脏替代治疗的CKD患者的识别，支持心脏损伤与ESRD的发展之间的联系。Amj Kidney Dis.58(5)：717-728。(C)2011年，由国家肾脏基金会公司提供。
Background: In patients with chronic kidney disease (CKD), as in other populations, elevations in cardiac biomarker levels predict increased risk of cardiovascular events. We examined the value of troponin T (TnT) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) in assessing the risk of developing end-stage renal disease (ESRD) in diabetic patients with CKD.Study Design: Prospective cohort study nested within a randomized clinical trial.Setting & Participants: Patients with type 2 diabetes, CKD (estimated glomerular filtration rate [eGFR], 20-60 mL/min/1.73 m(2)), and anemia enrolled in TREAT (Trial to Reduce Cardiovascular Events With Aranesp Therapy).Predictors: Serum levels of the cardiac biomarkers TnT and NT-pro-BNP.Outcomes: Incidence of ESRD and the composite of death or ESRD.Measurements: We measured TnT and NT-pro-BNP in baseline serum samples from the first 1,000 patients enrolled in TREAT. The relationship of these cardiac biomarker levels to the development of ESRD and death or ESRD was analyzed in multivariable regression models.Results: Detectable TnT (>= 0.01 ng/mL) was present in 45% of participants, and median NT-pro-BNP level was elevated at 605 pg/mL. Higher levels of both cardiac biomarkers were associated independently with higher rates of ESRD, as well as death or ESRD, and remained prognostically important after adjustment for eGFR, proteinuria, and other known predictors of CKD progression. The addition of cardiac biomarkers to a multivariable model for prediction of ESRD improved discrimination of those with and without an event by 16.9% (95% CI, 6.3%-27.4%).Limitations: Observational study in a clinical trial cohort; results require validation.Conclusions: In ambulatory patients with type 2 diabetes, anemia, and CKD, TnT and NT-pro-BNP levels frequently are elevated. These cardiac-derived biomarkers enhance prediction of ESRD beyond established risk factors. Measurement of TnT and NT-pro-BNP may improve the identification of patients with CKD who are likely to require renal replacement therapy, supporting a link between cardiac injury and the development of ESRD. AmJ Kidney Dis. 58(5):717-728. (C) 2011 by the National Kidney Foundation, Inc.