Cardiac biomarkers and survival in haemodialysis patients

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Abstract
Background  In dialysis patients, cardiac troponin T (cTNT) is often elevated despite the absence of acute myocardial ischaemia, and amino‐terminal pro‐B‐natriuretic peptide (NT‐proBNP) is markedly higher compared to non‐haemodialysis patients. In a longitudinal observation, we evaluated the association of cTNT and NT‐proBNP on cardiovascular morbidity and mortality in haemodialysis patients with and without fluid overload.Materials and methods  Plasma cTNT levels of 134 haemodialysis patients were measured before and after a dialysis session by 3rd generation electro‐chemoluminiscence immunoassay. NT‐proBNP was determined using a polyclonal antibody recognizing the N‐terminal fragment of BNP (Elecsys autoanalyzer 2010, Roche Diagnostics, Mannheim, Germany). Volume status was determined by a clinical score system. Cardiovascular morbidity and mortality were assessed over a follow‐up period of 36 months.Results  Plasma cTNT > 0·03 ng mL−1 was found in 39·6% of all patients. Patients with hypervolaemia had significantly higher cTNT levels compared to euvolaemic patients (median 0·054 ng mL−1, interquartile range 0·019–0·153 vs. 0·005 ng mL−1, < 0·001–0·034; P < 0·001). All haemodialysis patients had excessively high levels of NT‐proBNP (median 4524; interquartile range 2000–10 250 pg mL−1), and NT‐proBNP was significantly higher in hypervolaemic haemodialysis patients (11 988, 5307–19 242) compared to euvolaemic haemodialysis patients (3247, 1619–5574); P < 0·001. Receiver operator curves showed a threshold of cTNT > 0·026 ng mL−1 and NT‐proBNP > 5300 pg mL−1 as predictors of hypervolaemia. Asymptomatic chronic haemodialysis patients with cTNT > 0·026 ng mL−1 and NT‐proBNP > 5300 pg mL−1 were more likely to die due to cardiac events in the follow‐up period. Multivariate analysis documented that elevated cTNT and NT‐proBNP levels were highly predictive for cardiovascular events.Conclusions  Plasma levels of cTNT are elevated in approximately 40% and NT‐proBNP levels in 100% of asymptomatic chronic haemodialysis patients. Both parameters depend on volume status. Increased NT‐proBNP and cTNT are strongly associated with adverse outcome in end‐stage renal disease patients undergoing haemodialysis, and are a useful tool for risk stratification in chronic haemodialysis patients.

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