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Independent and incremental prognostic value of novel cardiac biomarkers in chronic hemodialysis patients


Obokata, M and Sunaga, H and Ishida, H and Ito, K and Ogawa, T and Ando, Y and Kurabayashi, M and Negishi, K, Independent and incremental prognostic value of novel cardiac biomarkers in chronic hemodialysis patients, American Heart Journal, 179 pp. 29-41. ISSN 0002-8703 (2016) [Refereed Article]

Copyright Statement

© 2016 Elsevier Inc. All rights reserved.

DOI: doi:10.1016/j.ahj.2016.05.018


Background End-stage renal disease is a major clinical and public health problem, and cardiovascular disease accounts for half of the mortality in hemodialysis patients. An existing mortality risk score (AROii score) or N-terminal pro–brain natriuretic peptide (NT-proBNP) level have modest predictive power, but there is room for improvement. There are emerging cardiac biomarkers (soluble isoforms of ST2 [sST2], galectin-3 [Gal-3]), and uremic toxicity (indoxyl sulfate). We sought to determine whether these biomarkers predict cardiovascular outcomes in hemodialysis patients and have incremental prognostic value over the clinical score and NT-proBNP level.

Methods A total of 423 hemodialysis patients were prospectively followed up for primary (all-cause death) and secondary end points (a composite of all-cause death or cerebrocardiovascular events).

Results During a mean follow-up of 2.1 ± 0.4 years, there were 48 all-cause deaths and 78 composite outcomes. Soluble isoforms of ST2, Gal-3, and NT-proBNP were associated with all-cause deaths but indoxyl sulfate was not in both log-rank test and receiver operating characteristic analysis. Both sST2 and Gal-3 had independent and incremental prognostic value for both outcomes over the AROii score and NT-proBNP. Although adding sST2 did not reclassify over the model-based AROii score and NT-proBNP for all-cause death, further addition of Gal-3 did. Subgroup analyses of patients with left ventricular ejection fraction measurement (n = 301) corroborated these results, where the 2 biomarkers remained independent and incremental for both all-cause death and composite outcome after adjusting for the risk score and the ejection fraction.

Conclusions Both sST2 and Gal-3 had independent and incremental prognostic values over NT-proBNP and an established risk score in patients with hemodialysis. Assessment of sST2 and Gal-3 further enhances risk stratification.

Item Details

Item Type:Refereed Article
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Negishi, K (Dr Kazuaki Negishi)
ID Code:110218
Year Published:2016
Web of Science® Times Cited:31
Deposited By:Menzies Institute for Medical Research
Deposited On:2016-07-20
Last Modified:2022-08-25

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