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Clinical Chemistry 50: 2233-2235, 2004; 10.1373/clinchem.2004.041566
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(Clinical Chemistry. 2004;50:2233-2235.)
© 2004 American Association for Clinical Chemistry, Inc.

Editorials

Cardiac Biomarkers in Renal Disease: The Fog Is Slowly Lifting

Scott J. Cameron1 and Gary B. Green1,2,a

1 Clinical Chemistry Division, Department of Pathology, and2 Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD

aAddress correspondence to this author at: Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 6-100, Baltimore, MD 21287. Fax 410-502-8881.

The first 300 words of the full text of this article appear below.

It has long been known that among patients with end-stage renal disease (ESRD), cardiac disease is the single greatest cause of mortality, accounting for nearly one half of all deaths (1). Among community-based populations, renal insufficiency is an independent predictor of the risk of subsequent ischemic heart disease, conferring a risk equivalent to that of diabetes (2). Furthermore, the presence of even moderate renal impairment in a patient presenting with an acute coronary syndrome (ACS) is a strong short-term prognostic indicator, significantly increasing the 30-day risk of myocardial infarction, heart failure, and cardiac death (3). Thus, a strong and pervasive link clearly exists between kidney failure and cardiac disease. The common challenge to the nephrologist, cardiologist, and emergency physician therefore lies in successfully recognizing those patients within their scope of practice who are most at risk, thereby allowing targeted application of interventions designed to circumvent adverse outcomes. Accordingly, there is an exigent need for the clinical laboratory to identify and make available reliable assays for biomarkers that can predict adverse events across a range of clinical settings and among patients with various degrees of kidney dysfunction, as well as to elucidate the performance characteristics and limitations of each of these markers.

A variety of individual biomarkers have previously been evaluated for this purpose, and several have been found to successfully predict outcome in patients with kidney disease. These include markers of myocardial necrosis, such as cardiac troponin T (cTnT) and I (cTnI) (4); markers of heart failure, such as B-type natriuretic peptide (BNP) and its associated inactive N-terminal fragment (NT-proBNP) (5); and the marker of systemic inflammation, high-sensitivity C-reactive protein (hsCRP) (6). However, fulfillment of the obvious potential of these biomarkers to have a positive impact on the . . . [Full Text of this Article]




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Inflammation, overhydration and cardiac biomarkers in haemodialysis patients: a longitudinal study
Nephrol. Dial. Transplant., August 19, 2009; (2009) gfp417v1.
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Haemodialysis patients longitudinally assessed by highly sensitive cardiac troponin T and commercial cardiac troponin T and cardiac troponin I assays
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U. Poge, T. M. Gerhardt, R. P. Woitas, C. Kragelund, L. Kober, and P. Hildebrandt
N-Terminal Pro-B-Type Natriuretic Peptide and Mortality in Coronary Heart Disease
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Cystatin C: A Marker of Renal Function or Something More?
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