Multimarker approach to risk stratification for long-term mortality in patients on chronic hemodialysis

Circulation Journal : Official Journal of the Japanese Circulation Society
Junnichi IshiiYukio Yuzawa

Abstract

We prospectively investigated the prognostic value of the combined use of cardiac troponin T (TnT), B-type natriuretic peptide (BNP), and high-sensitivity C-reactive protein (CRP) for long-term mortality in hemodialysis (HD) patients. METHODS AND RESULTS: Baseline measurements of TnT, BNP, and CRP were performed in 516 patients on chronic HD. Patients were followed up for 10 years. Using the Cox multivariate model with these 3 biomarkers as variables categorized into tertiles for mortality, a simplified score was obtained by underscoring individual biomarkers based on the adjusted hazard ratio (HR). The multimarker score was defined as the sum of these points. TnT, BNP, and CRP levels were individually independent predictors for mortality (P<0.05). Among low-risk (multimarker score <4), intermediate-risk (multimarker score 4-7), and high-risk (multimarker score ≥7) groups, 10-year survival rates were 83.3%, 54.3%, and 27.2% (P<0.0001), respectively. After adjusting for other confounders, the multimarker score had strong predictive power for mortality (HR: 4.26; P<0.0001 for high-risk vs. low-risk group). Furthermore, adding the multimarker score to a baseline model with established risk factors improved the C-index (P<0.01), ne...Continue Reading

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Citations

Feb 16, 2016·Circulation Journal : Official Journal of the Japanese Circulation Society·Terumasa HayashiYoshitaka Isaka
Mar 10, 2015·Circulation Journal : Official Journal of the Japanese Circulation Society·Michihiro Yoshimura
Oct 30, 2019·Jornal brasileiro de nefrologia : ʹorgão oficial de Sociedades Brasileira e Latino-Americana de Nefrologia·Bernard CanaudAllan Collins
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May 28, 2020·Cardiorenal Medicine·Wen-Ling YangUNKNOWN on behalf of the MONITOR Trial Investigations

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