Mortality Prediction Using Modern Peptide Biomarkers in Hemodialysis Patients - A Comparative Analysis

Artunc, Ferruh; Nowak, Albina; Müller, Christian; Heyne, Nils; Häring, Hans‐Ulrich; Friedrich, Björn

doi:10.1159/000368468

Cited by 23 publications

(18 citation statements)

References 28 publications

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“…From a clinical perspective, it is important to keep in mind that our NT‐proBNP cut‐off values (8742 pg/mL for 2‐year all‐cause mortality and 5335 pg/mL for 2‐year CV mortality) have high sensitivity (94.4%, 88.0%, respectively) and acceptable specificity (69.1%, 88.0%, respectively). The NT‐proBNP cut‐off value for 2‐year all‐cause mortality identified in this study were comparable with the value used in the previous studies .…”

Section: Discussionsupporting

confidence: 82%

Addition of Novel Biomarkers for Predicting All‐Cause and Cardiovascular Mortality in Prevalent Hemodialysis Patients

Yamashita

Mizuiri²,

Nishizawa³

et al. 2017

Ther Apher Dial

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Novel biomarkers might improve the prediction of mortality in hemodialysis (HD) patients. We simultaneously measured the levels of conventional and novel biomarkers [serum N-terminal pro-brain natriuretic peptide (NT-proBNP), intact fibroblast growth factor-23 (FGF23), β2-microglobulin (β2MG), cystatin C, and high-sensitivity C-reactive protein (hsCRP)] in 307 prevalent Japanese HD patients. There were 66 all-cause deaths, and 25 cardiovascular (CV) deaths during 2 years, which were assessed using Cox models and concordance (C)-statistics. The addition of NT-proBNP alone (P < 0.05) or NT-proBNP, hsCRP, and β2MG as a panel (C-statistics: 0.834 vs. 0.776, P < 0.01) to a conventional risk model composed of age, diabetes, and the serum albumin level significantly improved the prediction of 2-year all-cause mortality, and the addition of NT-proBNP and hsCRP as a panel to a conventional risk model composed of age significantly improved the prediction of 2-year CV mortality (P < 0.05) in Japanese prevalent HD patients. Neither FGF23 nor cystatin C improved mortality prediction.

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Section: Discussionsupporting

confidence: 82%

Addition of Novel Biomarkers for Predicting All‐Cause and Cardiovascular Mortality in Prevalent Hemodialysis Patients

Yamashita

Mizuiri²,

Nishizawa³

et al. 2017

Ther Apher Dial

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“…Previous clinical studies have demonstrated that abnormal ABI and biomarkers are robust predictors of mortality and cardiovascular outcomes in ESKD patients . Tanaka et al, demonstrated that the presence of abnormal ABI is a strong predictor of PAD outcomes, all‐cause mortality, and cardiovascular events in ESKD patients .…”

Section: Discussionmentioning

confidence: 99%

Ankle‐brachial index, arterial stiffness, and biomarkers in the prediction of mortality and outcomes in patients with end‐stage kidney disease

Otsuka

Nakanishi

Shimada

et al. 2019

Clinical Cardiology

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Background Although ankle‐brachial index (ABI) and brachial‐ankle pulse wave velocity (baPWV) are significant predictors of major adverse cardiovascular event (MACE), their prognostic value in association with biomarkers has not been fully evaluated in patients with end‐stage kidney disease (ESKD). Hypothesis We hypothesized that ABI/baPWV would provide better prognostic value independent of biomarkers in ESKD patients. Methods This study included 104 ESKD patients treated with maintenance hemodialysis who underwent ABI and baPWV examinations and laboratory tests, including brain‐natriuretic peptide, high‐sensitive cardiac troponin T (hs‐cTnT), and high‐sensitive C‐reactive protein (hs‐CRP). MACE was defined as a composite event of all‐cause death, acute coronary syndrome, and stroke. Results During a mean follow‐up of 3.6 ± 1.7 years, a total of 51 MACE were observed. The independent factors associated with MACE were age >75 years (adjusted hazard ratio [HR], 2.15; P < .05), abnormal ABI (adjusted HR, 2.01; P < .05), left ventricular ejection fraction (LVEF) <50% (adjusted HR, 3.33; P < .001), the upper tertile of hs‐cTnT (adjusted HR, 2.77; P < .05), and hs‐CRP (HR, 1.96; P < .05). However, baPWV did not remain as an independent predictor of MACE in the entire cohort and also in patients without abnormal ABI. The combination of predictors improves the predictive value of MACE, providing increased HR with 4.00 for abnormal ABI + hs‐CRP, 4.42 for abnormal ABI + hs‐cTnT, and 7.04 for abnormal ABI + LVEF <50% (all P < .001). Conclusion Abnormal ABI is a robust predictor of MACE independent of biomarkers and their combination provides better risk stratification compared with a single predictor in ESKD patients.

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“…Similarly, Olauson et al [22] reported a lack of association between serum FGF23 levels and increased mortality risk in a Swedish population, but the level of FGF23 was a risk factor for mortality in crude models among men with previous CVD [22]. In contrast, a recent study determining if peptide biomarkers can be useful to identify the risk of mortality among hemodialysis patients in a German population revealed that among the modern peptide biomarkers, only mid-regional pro-adrenomedullin and FGF23 showed an association with mortality [23]. These studies and our observed data indicate that though the determination of the FGF23 level in hemodialysis patients is controversial, it still holds a significant place in diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Elevated Fibroblast Growth Factor 23 Concentration: Prediction of Mortality among Chronic Kidney Disease Patients

et al. 2015

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Background: The osteocyte-derived hormone, fibroblast growth factor 23 (FGF23), regulates the phosphorus metabolism and suppresses 1,25-dihydroxyvitamin D production, thereby mitigating hyperphosphatemia in patients with renal disorders. An elevated FGF23 level is suggested to be an early biomarker of altered phosphorus metabolism in the initial stages of chronic kidney disease (CKD) and acts as a strong predictor of mortality in dialysis patients. In the Saudi population, there is no report on the FGF23 level in CKD patients to date. This study aims to estimate the plasma FGF23 levels in the Saudi population and to correlate it with its clinical manifestations in order to ascertain its role in the pathogenesis of CKD patients. Methods: The FGF23 level in the plasma samples was determined using ELISA in a diverse cohort of 89 cases with stage 3-5 CKD and 100 healthy subjects. The plasma FGF23 level was correlated with other biochemical parameters. Results: The results revealed that the FGF23 level was markedly elevated among CKD patients compared to the control group, and a significant inverse correlation was observed between the FGF23 level and glomerular filtration rate. FGF23 elevation was approximately 40-fold among stage 5 patients compared to the control, while the elevation of phosphate, parathyroid hormone (PTH) and alkaline phosphatase was 2-, 3- and 8-fold in this stage, respectively. Conclusion: Elevated FGF23 levels may have a strong correlation with the disease pathogenesis. In addition, FGF23 might be a future therapeutic target to intervene against the progression of CKD as well as to increase patient survivability.

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Mortality Prediction Using Modern Peptide Biomarkers in Hemodialysis Patients - A Comparative Analysis

Cited by 23 publications

References 28 publications

Addition of Novel Biomarkers for Predicting All‐Cause and Cardiovascular Mortality in Prevalent Hemodialysis Patients

Addition of Novel Biomarkers for Predicting All‐Cause and Cardiovascular Mortality in Prevalent Hemodialysis Patients

Ankle‐brachial index, arterial stiffness, and biomarkers in the prediction of mortality and outcomes in patients with end‐stage kidney disease

Elevated Fibroblast Growth Factor 23 Concentration: Prediction of Mortality among Chronic Kidney Disease Patients

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