HCPLive Network

Including Newer Biomarkers in Testing Improves Death Prediction in Chronic Kidney Disease

Though patients with chronic kidney disease (CKD) have variable risks of death, the population risk prediction tools that are currently available perform poorly. 
 
To establish more satisfactory prediction models, Adeera Levin, MD, and colleagues from the Division of Nephrology of the Department of Medicine of the University of British Columbia undertook the Canadian Study of Prediction of Death, Dialysis and Interim Cardiovascular Events (CanPREDDICT) — a large, prospective cohort study that began in 2008 — and reported their findings at Kidney Week 2013, the American Society of Nephrology's annual  meeting held November 5-10, 2013, in Atlanta, GA.
 
In that study, 2,544 CKD patients referred from 25 rural, urban, academic, and non-academic centers throughout Canada underwent baseline newer biomarker (NMB) tests, which included asymmetric dimethylarginine (ADMA), high sensitivity C-reactive protein (hsCRP), interleukin 6, N-terminal pro-brain natriuretic peptide (NTproBNP), troponin I, transforming growth factor beta 1 (TGFβ1), cystatin C, and fibroblast growth factor (FGF23). The mean age of the cohort was 68 years old, while the median estimated glomerular filtration rate (eGFR) was 28ml/min/1.73m2. According to the researchers, 48% of patients had diabetes,  and 15.5% died during the 3-year follow-up.
 
Patients were followed for 3 years at 6-month intervals and annually monitored for traditional biomarkers, such as eGFR, urine albumin creatinine ratio (uACR), hemoglobin (Hgb), and phosphate and albumin. The researchers also performed the aforementioned NMB tests after collecting blood and urine samples on schedule.
 
To investigate whether including NBMs improve the prediction of death risk in CKD patients to a greater extent than conventional clinical, demographic, and laboratory predictors, the researchers compared discrimination (C statistic) and classification (NRI) of proportional hazard models based on conventional markers versus a combination of conventional and NBM markers.
 
After adjusting for base predictors, they found that the biomarker NTproBNP was the best predictor of mortality (NRI=8.9; 95% confidence interval [CI]: 3.3-17.4), followed by hsCRP (NRI=4.5; 95% CI: 1.3-9.6) and FGF23 (NRI=3.1; 95% CI: 0.4-11.4).
 
While the authors found that including NBMs in risk prediction models significantly improves the precision of death prediction in CKD patients, they noted that their approach needs to be validated with further testing.
 
The authors disclosed support from Ortho Janssen.


Further Reading
App will help patients with diabetes log their hypoglycemic events and achieve better control of these events by becoming more aware of preceding signs and symptoms.
Provocative research raises the question of whether we should we look at Alzheimer’s disease as “type 3 diabetes.”
Presentation at CMHC 2014 provides updates on emerging classes of diabetes treatment, including preliminary data from current clinical trials.
In remarks delivered at the American Academy of Family Physicians 2014 Assembly, HHS Secretary Sylvia Mathews Burwell spoke about the ongoing response to the Ebola outbreak, improving health care delivery, the Affordable Care Act, and the Transforming Clinical Practice Initiative.
Seniors who wear their dentures when they sleep are at increased risk for pneumonia, according to a study published online Oct. 7 in the Journal of Dental Research.
New York and New Jersey health officials announced today that all health care workers returning from caring for patients in Ebola hot zones in West Africa will have to go into quarantine for 21 days. The new policy is stricter than the current one recommended by the US Centers for Disease Control and Prevention that calls for health monitoring for 21 days. It was that policy that allowed Craig Spencer, MD to be out and about a day before he was diagnosed with Ebola Thursday and rushed to city-run Bellevue Hospital Center in Manhattan.
A pattern of sleep disturbance is a risk factor for depression and suicide and also increases the risk of cancer, infection, hypertension, weight gain, heart disease, diabetes, inflammation, osteoporosis, chronic pain, and arrhythmias. It can also have a significant negative impact on cognition and creativity.
More Reading
App will help patients with diabetes log their hypoglycemic events and achieve better control of these events by becoming more aware of preceding signs and symptoms.