Cargando…

Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study

BACKGROUND: Sudden cardiac death (SCD) is the most common etiology of death in hemodialysis patients but not much is known about its risk factors. The goal of our study was to determine the association and risk prediction of SCD by serum N-terminal prohormone of brain natriuretic peptide (NTproBNP)...

Descripción completa

Detalles Bibliográficos
Autores principales: Kruzan, Rachel M., Herzog, Charles A., Wu, Aozhou, Sang, Yingying, Parekh, Rulan S., Matsushita, Kunihiro, Hwang, Seungyoung, Cheng, Alan, Coresh, Josef, Powe, Neil R., Shafi, Tariq
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761195/
https://www.ncbi.nlm.nih.gov/pubmed/26897129
http://dx.doi.org/10.1186/s12882-016-0230-x
_version_ 1782416948059963392
author Kruzan, Rachel M.
Herzog, Charles A.
Wu, Aozhou
Sang, Yingying
Parekh, Rulan S.
Matsushita, Kunihiro
Hwang, Seungyoung
Cheng, Alan
Coresh, Josef
Powe, Neil R.
Shafi, Tariq
author_facet Kruzan, Rachel M.
Herzog, Charles A.
Wu, Aozhou
Sang, Yingying
Parekh, Rulan S.
Matsushita, Kunihiro
Hwang, Seungyoung
Cheng, Alan
Coresh, Josef
Powe, Neil R.
Shafi, Tariq
author_sort Kruzan, Rachel M.
collection PubMed
description BACKGROUND: Sudden cardiac death (SCD) is the most common etiology of death in hemodialysis patients but not much is known about its risk factors. The goal of our study was to determine the association and risk prediction of SCD by serum N-terminal prohormone of brain natriuretic peptide (NTproBNP) troponin I (cTnI) in hemodialysis patients. METHODS: We measured NTproBNP and cTnI in 503 hemodialysis patients of a national prospective cohort study. We determined their association with SCD using Cox regression, adjusting for demographics, co-morbidities, and clinical factors and risk prediction using C-statistic and Net Reclassification Improvement (NRI). RESULTS: Patients’ mean age was 58 years and 54 % were male. During follow-up (median 3.5 years), there were 75 outpatient SCD events. In unadjusted and fully-adjusted models, NTproBNP had a significant association with the risk of SCD. Analyzed as a continuous variable, the risk of SCD increased 27 % with each 2-fold increase in NTproBNP (HR, 1.27 per doubling; 95 % CI, 1.13–1.43; p < 0.001). In categorical models, the risk of SCD was 3-fold higher in the highest tertile of NTproBNP (>7,350 pg/mL) compared with the lowest tertile (<1,710 pg/mL; HR for the highest tertile, 3.03; 95 % CI, 1.56–5.89; p = 0.001). Higher cTnI showed a trend towards increased risk of SCD in fully adjusted models, but was not statistically significant (HR, 1.17 per doubling; 95 % CI, 0.98–1.40; p = 0.08). Sensitivity analyses using competing risk models showed similar results. Improvement in risk prediction by adding cardiac biomarkers to conventional risk factors was greater with NTproBNP (C-statistic for 3-year risk: 0.810; 95 % CI, 0.757 to 0.864; and continuous NRI: 0.270; 95 % CI, 0.046 to 0.495) than with cTnI. CONCLUSIONS: NTproBNP is associated with the risk of SCD in hemodialysis patients. Further research is needed to determine if biomarkers measurement can guide SCD risk prevention strategies in dialysis patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12882-016-0230-x) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-4761195
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-47611952016-02-21 Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study Kruzan, Rachel M. Herzog, Charles A. Wu, Aozhou Sang, Yingying Parekh, Rulan S. Matsushita, Kunihiro Hwang, Seungyoung Cheng, Alan Coresh, Josef Powe, Neil R. Shafi, Tariq BMC Nephrol Research Article BACKGROUND: Sudden cardiac death (SCD) is the most common etiology of death in hemodialysis patients but not much is known about its risk factors. The goal of our study was to determine the association and risk prediction of SCD by serum N-terminal prohormone of brain natriuretic peptide (NTproBNP) troponin I (cTnI) in hemodialysis patients. METHODS: We measured NTproBNP and cTnI in 503 hemodialysis patients of a national prospective cohort study. We determined their association with SCD using Cox regression, adjusting for demographics, co-morbidities, and clinical factors and risk prediction using C-statistic and Net Reclassification Improvement (NRI). RESULTS: Patients’ mean age was 58 years and 54 % were male. During follow-up (median 3.5 years), there were 75 outpatient SCD events. In unadjusted and fully-adjusted models, NTproBNP had a significant association with the risk of SCD. Analyzed as a continuous variable, the risk of SCD increased 27 % with each 2-fold increase in NTproBNP (HR, 1.27 per doubling; 95 % CI, 1.13–1.43; p < 0.001). In categorical models, the risk of SCD was 3-fold higher in the highest tertile of NTproBNP (>7,350 pg/mL) compared with the lowest tertile (<1,710 pg/mL; HR for the highest tertile, 3.03; 95 % CI, 1.56–5.89; p = 0.001). Higher cTnI showed a trend towards increased risk of SCD in fully adjusted models, but was not statistically significant (HR, 1.17 per doubling; 95 % CI, 0.98–1.40; p = 0.08). Sensitivity analyses using competing risk models showed similar results. Improvement in risk prediction by adding cardiac biomarkers to conventional risk factors was greater with NTproBNP (C-statistic for 3-year risk: 0.810; 95 % CI, 0.757 to 0.864; and continuous NRI: 0.270; 95 % CI, 0.046 to 0.495) than with cTnI. CONCLUSIONS: NTproBNP is associated with the risk of SCD in hemodialysis patients. Further research is needed to determine if biomarkers measurement can guide SCD risk prevention strategies in dialysis patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12882-016-0230-x) contains supplementary material, which is available to authorized users. BioMed Central 2016-02-20 /pmc/articles/PMC4761195/ /pubmed/26897129 http://dx.doi.org/10.1186/s12882-016-0230-x Text en © Kruzan et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Kruzan, Rachel M.
Herzog, Charles A.
Wu, Aozhou
Sang, Yingying
Parekh, Rulan S.
Matsushita, Kunihiro
Hwang, Seungyoung
Cheng, Alan
Coresh, Josef
Powe, Neil R.
Shafi, Tariq
Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study
title Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study
title_full Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study
title_fullStr Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study
title_full_unstemmed Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study
title_short Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study
title_sort association of ntprobnp and ctni with outpatient sudden cardiac death in hemodialysis patients: the choices for healthy outcomes in caring for esrd (choice) study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761195/
https://www.ncbi.nlm.nih.gov/pubmed/26897129
http://dx.doi.org/10.1186/s12882-016-0230-x
work_keys_str_mv AT kruzanrachelm associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy
AT herzogcharlesa associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy
AT wuaozhou associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy
AT sangyingying associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy
AT parekhrulans associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy
AT matsushitakunihiro associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy
AT hwangseungyoung associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy
AT chengalan associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy
AT coreshjosef associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy
AT poweneilr associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy
AT shafitariq associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy