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Article: Diagnostic potential of serum biomarkers for left ventricular abnormalities in chronic peritoneal dialysis patients

TitleDiagnostic potential of serum biomarkers for left ventricular abnormalities in chronic peritoneal dialysis patients
Authors
Issue Date2009
PublisherOxford University Press. The Journal's web site is located at http://ndt.oxfordjournals.org/
Citation
Nephrology Dialysis Transplantation, 2009, v. 24 n. 6, p. 1962-1969 How to Cite?
AbstractBackground. N-terminal-pro-brain natriuretic peptide, cardiac troponin T (cTnT) and high sensitivity C-reactive protein (hs-CRP) have been shown to predict mortality and cardiovascular outcomes in end-stage renal disease patients. However, it is not known which biomarkers have the strongest diagnostic potential for left ventricular (LV) abnormalities in chronic peritoneal dialysis (PD) patients, nor whether residual renal function may confound the diagnostic potential of these biomarkers.Methods. Two hundred and thirty chronic PD patients underwent two-dimensional echocardiography to determine LV hypertrophy and ejection fraction and had simultaneous measurement of serum NT-pro-BNP, cTnT and hs-CRP.Results. A significant gain in predictive power was observed when NT-pro-BNP or cTnT but not hs-CRP was included in the multivariable logistic regression models for severe LV hypertrophy (defined as LV mass index ≥ upper tertile, 247.8 gm 2) and systolic dysfunction (defined as ejection fraction ≤45). Using ROC curve analysis, NT-pro-BNP had the highest diagnostic value for severe LV hypertrophy and systolic dysfunction compared to cTnT and hs-CRP, irrespective of residual renal function. An analysis based on the best cut-off threshold showed that NT-pro-BNP and cTnT had a negative predictive value of 87.1 and 92.6 for severe LV hypertrophy and 95.4 and 93.2 for systolic dysfunction, respectively. Furthermore, the best cut-off threshold of NT-pro-BNP and cTnT for excluding severe LV hypertrophy and systolic dysfunction was nearly 3-fold higher in anuric patients than in patients with residual renal function.Conclusions. Serum NT-pro-BNP appeared most useful in excluding systolic dysfunction in chronic PD patients followed by cTnT. hs-CRP was not useful in this regard. Residual renal function confounded the interpretation of these biomarkers and reduced their predictive power. A nearly 30 higher cut-off threshold of NT-pro-BNP and cTnT had to be applied in anuric PD patients.
Persistent Identifierhttp://hdl.handle.net/10722/59140
ISSN
2015 Impact Factor: 4.085
2015 SCImago Journal Rankings: 1.780
ISI Accession Number ID
Funding AgencyGrant Number
Hong Kong Health Service Research Fund6901023
Funding Information:

The study was supported by the grant from the Hong Kong Health Service Research Fund (project code: 6901023) of which Dr Angela Yee-Moon Wang was the Principal Investigator.

References

 

DC FieldValueLanguage
dc.contributor.authorWang, AYMen_HK
dc.contributor.authorLam, CWKen_HK
dc.contributor.authorWang, Men_HK
dc.contributor.authorChan, IHSen_HK
dc.contributor.authorLui, SFen_HK
dc.contributor.authorZhang, Yen_HK
dc.contributor.authorSanderson, JEen_HK
dc.date.accessioned2010-05-31T03:43:40Z-
dc.date.available2010-05-31T03:43:40Z-
dc.date.issued2009en_HK
dc.identifier.citationNephrology Dialysis Transplantation, 2009, v. 24 n. 6, p. 1962-1969en_HK
dc.identifier.issn0931-0509en_HK
dc.identifier.urihttp://hdl.handle.net/10722/59140-
dc.description.abstractBackground. N-terminal-pro-brain natriuretic peptide, cardiac troponin T (cTnT) and high sensitivity C-reactive protein (hs-CRP) have been shown to predict mortality and cardiovascular outcomes in end-stage renal disease patients. However, it is not known which biomarkers have the strongest diagnostic potential for left ventricular (LV) abnormalities in chronic peritoneal dialysis (PD) patients, nor whether residual renal function may confound the diagnostic potential of these biomarkers.Methods. Two hundred and thirty chronic PD patients underwent two-dimensional echocardiography to determine LV hypertrophy and ejection fraction and had simultaneous measurement of serum NT-pro-BNP, cTnT and hs-CRP.Results. A significant gain in predictive power was observed when NT-pro-BNP or cTnT but not hs-CRP was included in the multivariable logistic regression models for severe LV hypertrophy (defined as LV mass index ≥ upper tertile, 247.8 gm 2) and systolic dysfunction (defined as ejection fraction ≤45). Using ROC curve analysis, NT-pro-BNP had the highest diagnostic value for severe LV hypertrophy and systolic dysfunction compared to cTnT and hs-CRP, irrespective of residual renal function. An analysis based on the best cut-off threshold showed that NT-pro-BNP and cTnT had a negative predictive value of 87.1 and 92.6 for severe LV hypertrophy and 95.4 and 93.2 for systolic dysfunction, respectively. Furthermore, the best cut-off threshold of NT-pro-BNP and cTnT for excluding severe LV hypertrophy and systolic dysfunction was nearly 3-fold higher in anuric patients than in patients with residual renal function.Conclusions. Serum NT-pro-BNP appeared most useful in excluding systolic dysfunction in chronic PD patients followed by cTnT. hs-CRP was not useful in this regard. Residual renal function confounded the interpretation of these biomarkers and reduced their predictive power. A nearly 30 higher cut-off threshold of NT-pro-BNP and cTnT had to be applied in anuric PD patients.en_HK
dc.languageengen_HK
dc.publisherOxford University Press. The Journal's web site is located at http://ndt.oxfordjournals.org/en_HK
dc.relation.ispartofNephrology Dialysis Transplantationen_HK
dc.subject.meshAgeden_HK
dc.subject.meshBiological Markers - blooden_HK
dc.subject.meshC-Reactive Protein - metabolismen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHumansen_HK
dc.subject.meshHypertrophy, Left Ventricular - blood - diagnosis - etiologyen_HK
dc.subject.meshKidney Failure, Chronic - blood - complications - therapyen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshNatriuretic Peptide, Brain - blooden_HK
dc.subject.meshPeptide Fragments - blooden_HK
dc.subject.meshPeritoneal Dialysisen_HK
dc.subject.meshPredictive Value of Testsen_HK
dc.subject.meshProspective Studiesen_HK
dc.subject.meshSystoleen_HK
dc.subject.meshTroponin T - blooden_HK
dc.titleDiagnostic potential of serum biomarkers for left ventricular abnormalities in chronic peritoneal dialysis patientsen_HK
dc.typeArticleen_HK
dc.identifier.emailWang, M:meiwang@hkucc.hku.hken_HK
dc.identifier.authorityWang, M=rp00281en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1093/ndt/gfp067en_HK
dc.identifier.pmid19237403-
dc.identifier.scopuseid_2-s2.0-67651099000en_HK
dc.identifier.hkuros155822en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-67651099000&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume24en_HK
dc.identifier.issue6en_HK
dc.identifier.spage1962en_HK
dc.identifier.epage1969en_HK
dc.identifier.isiWOS:000266355500041-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridWang, AYM=13606226000en_HK
dc.identifier.scopusauthoridLam, CWK=7402527629en_HK
dc.identifier.scopusauthoridWang, M=7406690398en_HK
dc.identifier.scopusauthoridChan, IHS=8298775100en_HK
dc.identifier.scopusauthoridLui, SF=7102379144en_HK
dc.identifier.scopusauthoridZhang, Y=7601312580en_HK
dc.identifier.scopusauthoridSanderson, JE=7202371250en_HK

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