Use of Novel and Conventional Cardiac Biomarkers to Assess Cardiovascular Risk in Hemodialysis Patients
- Hemodialysis: Biomarkers, Translational Research
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
- 801 Dialysis: Hemodialysis and Frequent Dialysis
- Neronha, Zachary J., Washington University in St Louis School of Medicine, St Louis, Missouri, United States
- Chuu, Andy, Washington University in St Louis School of Medicine, St Louis, Missouri, United States
- O Brien, Frank J., Washington University in St Louis School of Medicine, St Louis, Missouri, United States
Hemodialysis patients experience greatly increased morbidity and mortality. Although the underlying etiology is not completely understood, volume overload likely plays an important role given their elevated risk of cardiovascular disease and especially heart failure. Biomarkers are commonly used to clinically assess volume status in cardiology patients, but cardiac biomarker use in dialysis patients is complicated by an incomplete understanding of biomarker clearance during dialysis and the complex interplay of renal and cardiac causes of volume overload. Here, we investigate a panel of conventional and novel cardiac biomarkers in a group of hemodialysis patients catagorized by their baseline ejection fraction.
We performed a descriptive, prospective cohort study utilizing a group of hemodialysis patients at the Chromalloy American Kidney Center, an outpatient hemodialysis center in St. Louis, MO serving approximately 150 ESRD patients. Study enrollment was randomized, and consisted of 35 patients seperated into 3 groups with ejection fractions <40%, 40-50%, and >50% based on a recent echocardiogram. The mean age was 62 and 94% were African American. Pre-dialysis blood was drawn to measure NT-proBNP, high-sensitivity troponin T (hsTnT), galectin-3, growth differentiation factor-15 (GDF-15), and soluble ST2 (sST2).
Randomization produced a distribution of patients across the cohorts that was relatively equivalent in age, ethnicity and gender and differed with respect to EF. Preliminary data suggests that within our cohort, ejection fraction influenced novel cardiac biomarker expression. Patients with a lower ejection fraction had biomarker expression more suggestive of volume overload than those with preserved ejection fraction. Those with an EF of >50% also had a high level of cardiac biomarker expression.
Preliminary analysis of the baseline characteristics of this patient cohort suggests cardiac biomarker expression is influenced by ejection fraction. More study is needed to evaluate how cardiac biomarker data varies with volume optimization, and any predictive value it may have for major adverse cardiovascular events. We therefore plan to follow this patient cohort for an additional year to assess any changes in biomarker expression, future adverse events, and the impact of volume optimization on biomarker expression.