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Abstract: PO1163

Routinely Measured Cardiac Troponin I and NT-ProBNP as Predictors of Mortality in Japanese Hemodialysis Patients: The Dialysis Outcomes and Practice Patterns Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Lopes, Marcelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Eriguchi, Masahiro, Nara Daigaku, Nara, Nara, Japan
  • Tsuruya, Kazuhiko, Nara Daigaku, Nara, Nara, Japan
  • Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Pecoits-Filho, Roberto, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • McCullough, Keith, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Kanda, Eiichiro, Kawasaki Ika Daigaku, Kurashiki, Okayama, Japan
  • Iseki, Kunitoshi, Nakamura Naika Iin, Kumamoto, Kumamoto, Japan
  • Hirakata, Hideki, Fukuoka Renal Clinic, Fukuoka, Japan
Background

Due to the interplay of chronic kidney disease and the heart, it is common for myocardial damage and strain to be present in hemodialysis (HD) patients. The cardiac troponin I (cTnI) and NT-proBNP are widely used as cardiac biomarkers to evaluate the patients at high risk for cardiovascular disease (CVD). However international The Dialysis Outcomes and Practice Patterns Study (DOPPS) data indicate that these cardiac biomarkers are measured in fewer than 2% of HD patients in real-world practice.

Methods

Pre-dialysis levels of cTnI and NT-proBNP at study enrollment were measured in 1176 prevalent Japanese HD patients (DOPPS phase 5). Cox regression was used to test the association of the cardiac biomarkers with all-cause mortality, adjusting for potential confounders. Subgroup analyses were performed to assess potential effect modification of clinical characteristics: age, systolic blood pressure, HD vintage, diabetes mellitus, CVD, and heart failure.

Results

Median [IQR] cTnI (99th percentile; 0.04 ng/mL) and NT-proBNP levels were 0.018 [0.005, 0.04] ng/mL and 3432 [1580, 8017] pg/mL, respectively. There were 175 deaths during a median [IQR] follow-up of 2.8 [2.3, 2.9] years. Higher levels of both cardiac biomarkers were incrementally associated with mortality after adjustment for potential confounders. Even after adjustment for the alternative cardiac biomarker, the HRs of death for cTnI >0.04 and NT-proBNP >8000 pg/mL versus those references (cTnI <0.01 and NT-proBNP <2000) were 2.67 (95% CI 1.47-4.87) and 2.05 (95% CI 1.10-3.84), respectively and still remained significant. Subgroup analyses showed the associations of both cardiac biomarkers with mortality were consistent between stratified groups. (the p values for interaction were >0.10 for all stratified models).

Conclusion

Routinely measured NT-proBNP and cTnI are strongly associated with mortality among prevalent Japanese HD patients. These associations were still significant even after adjustment for the alternative biomarker, suggesting that cTnI and NT-proBNP may reflect different pathologic aspects for cardiac abnormalities.