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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


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Volume 51, Issue 9

Issues

A combined index of cardiac biomarkers as a risk factor for early cardiovascular mortality in hemodialysis patients

Anne-Sophie Bargnoux
  • Department of Biochemistry, Lapeyronie University Hospital, University Montpellier 1, Montpellier, France
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/ Marion Morena
  • Department of Biochemistry, Lapeyronie University Hospital, University Montpellier 1, Montpellier, France
  • Renal Research and Training Institute, Lapeyronie University Hospital, Montpellier, France
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/ Isabelle Jaussent
  • French National Institute of Health and Medical Research, INSERM, U1061, University Montpellier 1, Montpellier, France
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/ Francois Maurice / Lotfi Chalabi
  • Association pour l’Installation à Domicile des Epurations Renales (AIDER), Montpellier, France
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/ Hélène Leray-Moragues
  • Department of Nephrology, Lapeyronie University Hospital, University Montpellier 1, Montpellier, France
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/ Nathalie Terrier
  • Department of Biochemistry, Lapeyronie University Hospital, University Montpellier 1, Montpellier, France
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/ Anne-Marie Dupuy
  • Department of Biochemistry, Lapeyronie University Hospital, University Montpellier 1, Montpellier, France
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/ Stéphanie Badiou
  • Department of Biochemistry, Lapeyronie University Hospital, University Montpellier 1, Montpellier, France
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/ Bernard Canaud
  • Renal Research and Training Institute, Lapeyronie University Hospital, Montpellier, France
  • Association pour l’Installation à Domicile des Epurations Renales (AIDER), Montpellier, France
  • Department of Nephrology, Lapeyronie University Hospital, University Montpellier 1, Montpellier, France
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/ Jean-Paul Cristol
  • Corresponding author
  • Department of Biochemistry, Lapeyronie University Hospital, University Montpellier 1, Montpellier, France
  • Renal Research and Training Institute, Lapeyronie University Hospital, Montpellier, France
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Published Online: 2013-02-12 | DOI: https://doi.org/10.1515/cclm-2012-0664

Abstract

Background: Cardiac biomarkers, including cardiac troponin-I (cTn-I) and N-terminal pro brain natriuretic peptide (NT-proBNP) have been associated with poor outcome in hemodialysis (HD) patients. The present study was designed to evaluate these biomarkers as biological risk factors for early and late mortality in HD patients. In addition, a multimarker approach including inflammatory index was performed in order to improve the cardiovascular risk assessment of these patients.

Methods: cTnI, NT-proBNP and C-reactive protein (CRP) were measured at baseline (October through November 2002) in 130 HD patients [median age 69.0 (23.4–87.7) years old, 76 females, 54 males]. Patients were followed during 8 years. Adjusted hazard ratios (HRs) of death and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models.

Results: During the follow-up, 82 patients died, mainly from cardiac cause (63.4%). Elevated cTnI, NT-proBNP or CRP were all associated with increased early (death within 2 years of follow-up) but not late mortality. Moreover, the combination of all parameters (CRP ≥10.51 mg/L and cTnI ≥0.037 µg/L and NT-proBNP ≥10,204 pg/mL) dramatically increased the short-term mortality especially the cardiovascular mortality (HR 8.58, 95% CI 1.59–46.2; p=0.0007).

Conclusions: A combined index of cardiovascular risk factors could provide supplementary risk stratification in HD patients for early cardiovascular mortality, strongly supporting the annual routine determination of these biomarkers.

Keywords: cardiac troponin-I (cTnI); cardiovascular disease; C-reactive protein (CRP); hemodialysis; mortality; N-terminal pro brain natriuretic peptide (NT-proBNP)

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About the article

Corresponding author: Jean-Paul Cristol, Department of Biochemistry, Lapeyronie University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier cedex 5, France, Phone: +33 467 338314, Fax: +33 467 338393


Received: 2012-10-02

Accepted: 2013-01-14

Published Online: 2013-02-12

Published in Print: 2013-09-01


Citation Information: Clinical Chemistry and Laboratory Medicine, Volume 51, Issue 9, Pages 1865–1874, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2012-0664.

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