Prognostic values of cardiac biomarkers screening in dialysis patients

Simona Hogas, Petru Cianga, Daniela Constantinescu, Corina Cianga, Luminita Voroneanu, Raluca Popa, Stefana Catalina Bîlha, Adrian Covic


Patients with chronic kidney disease (CKD) have an increased cardiovascular (CV) risk and a higher mortality rate. This case report aims to reveal the prognostic value of cardiac biomarkers in patients with CKD stage 5 on dialysis. Several biomarkers have proven their utility for early detection of CV risk in dialysis patients. Most promising biomarkers are: N-terminal pro–B-type (NT-proBNP), high sensitivity cardiac troponin T (Hs–cTnT), Cardiotrophin-1 (CT-1) and Galectin-3 (GAL-3). We report the case of a 44 year-old woman with end stage renal disease on dialysis without any cardiac pathology, but who had, at screening evaluation, high values of cardiac biomarkers, with increasing levels of NT-proBNP at serial determination; Hs-cTnT was constant. Recently, our patient was admitted in cardiology unit with unstable ischemic cardiopathy. In this context, we review the prognostic value of cardiac biomarkers in CV morbidity and mortality. The particularity of this case was the preemptive assessment of cardiac biomarkers. High serum levels of these biomarkers, in a patient without any cardiac concerns at evaluation moment, should promote for early invasive investigations.


chronic kidney disease, dialysis, high sensitivity cardiac troponin T, N-terminal pro–B-type, cardiotrophin-1, galectin-3

Full Text:



Collins AJ, Foley RN, Chavers B, et al. United States renal data system 2011 annual data report: atlas of chronic kidney disease & end-stage renal disease in the United States. Am J Kidney Dis 2012; 59:A7; e1-420.

Voroneanu L, Siriopol D, Nistor I, et al. Superior predictive value for NTproBNP compared with high sensitivity cTnT in dialysis patients: a pilot prospective observational study. Kidney Blood Press Res 2014; 39(6):636-647.

Reichlin T, Hochholzer W, Bassetti S, et al. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med 2009; 361:858-867.

Artunc F, Mueller C, Breidthardt T, et al. Sensitive troponins--which suits better for hemodialysis patients? Associated factors and prediction of mortality. PLoS One 2012; 7:e47610.

Pennica D, King KL, Shaw KJ et al. Expression cloning of cardiotrophin 1 a cytokine that induces cardiac myocyte hypertrophy. Proc. Natl. Acad. Sci 1995; 92:1142-1146.

Lopez B, Gonzalez A, Querejeta R, Larman M, Rabago G, Diez J. Association of cardiotrophin-1 with myocardial fibrosis in hypertensive patients with heart failure. Hypertension 2014; 63:483-489.

López B, González A, Lasarte JJ, et al. Is plasma cardiotrophin-1 a marker of hypertensive heart disease? J Hypertens 2005; 23:625–632.

Filipe MD, Meijers WC, van der Velde AR, Boer RA. Galectin-3 and heart failure: prognosis, prediction and clinical utility. Clin Chim Acta 2015; 443:48-56.

de Boer A, van Veldhuisen DJ, Gansevoort RT, et al. The fibrosis marker galectin-3 and outcome in the general population. J Intern Med 2012; 272:55–64.

Ho JE, Liu C, Lyass A, et al. Galectin-3, a marker of cardiac fibrosis, predicts incident heart failure in the community. J Am Coll Cardiol 2012; 60:1249–1256.

Grandin EW, Jarolim P, Murphy SA, et al. Galectin-3 and the development of heart failure after acute coronary syndrome: pilot experience from PROVE IT-TIMI 22. Clin Chem 2012; 58:267–273.

Kwan G, Isakson SR, Beede J, Clopton P, Maisel AS, Fitzgerald RL. Short-term serial sampling of natriuretic peptides in patients presenting with chest pain. J Am Coll Cardiol 2007; 49(11):1186-1192.

Christiane Drechsler, Graciela Delgado, Christoph Wanner, et al. Galectin-3, Renal Function, and Clinical Outcomes: Results from the LURIC and 4D Studies. JASN 2015. ASN.2014010093; J Am Soc Nephrol 2015; 7; 26(9):2213-2221.

Bielecka-Dabrowa A, Gluba-Brzozka A, Michalska-Kasiczak M, Misztal M, Rysz J, Banach M. The multi-biomarker approach for heart failure in patients with hypertension. Int J Mol Sci 2015; 16:10715-10733.

Berger R, Huelsman M, Strecker K, et al. B-type natriuretic peptide predicts sudden death in patients with chronic heart failure. Circulation 2002; 105(20):2392-7.

Schnabel R, Lubos E, Rupprecht HJ, et al. B-type natriuretic peptide and the risk of cardiovascular events and death in patients with stable angina: results from the AtheroGene study. J Am Coll Cardiol 2006; 47(3):552-558.

Kragelund C, Gronning B, Kober L, Hildebrandt P, Steffensen R. N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease. N Engl J Med 2005; 352(7):666-675.

Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013; 128(16):e240-327.

Paniagua R, Ventura MD, Avila-Díaz M, et al. NT-proBNP, fluid volume overload and dialysis modality are independent predictors of mortality in ESRD patients. Nephrol Dial Transplant 2010; 25:551-557.

Konii H, Sato K, Kikuchi S, et al. Stimulatory effects of cardiotrophin-1 on atherosclerosis. Hypertension 2013; 62:942-950.

Lopez Andres N, Calvier L, Labat C, et al. Absence of cardiotrophin 1 is associated with decreased age-dependent arterial stiffness and increased longevity in mice. Hypertension 2013; 61:120-129.


Copyright (c) 2015 Archive of Clinical Cases

Creative Commons License
Archive of Clinical Cases is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


ISSN: 2360-6975