B-Type Natriuretic Peptide and Cardiac Troponin I Are Associated With Adverse Outcomes in Stable Kidney Transplant Recipients

• Published in: Transplantation Vol. 101; no. 1; pp. 182 - 190
• Main Authors: Jarolim, Petr, Claggett, Brian L, Conrad, Michael J, Carpenter, Myra A, Ivanova, Anastasia, Bostom, Andrew G, Kusek, John W, Hunsicker, Lawrence G, Jacques, Paul F, Gravens-Mueller, Lisa, Finn, Peter, Solomon, Scott D, Weiner, Daniel E, Levey, Andrew S, Pfeffer, Marc A
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-01-2017
• Subjects: Adult; Biomarkers - blood; Cardiovascular Diseases - blood; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Case-Control Studies; Female; Humans; Kidney Transplantation - adverse effects; Kidney Transplantation - mortality; Male; Middle Aged; Natriuretic Peptide, Brain - blood; Predictive Value of Tests; Randomized Controlled Trials as Topic; Risk Factors; Transplant Recipients; Treatment Outcome; Troponin I - blood; Up-Regulation
• ISSN: 0041-1337; 1534-6080
• DOI: 10.1097/TP.0000000000001080

BACKGROUNDApproximately 200 000 kidney transplant recipients are living in the United States; they are at increased risk for cardiovascular and other adverse outcomes. Biomarkers predicting these outcomes are needed. Using specimens collected during the Folic Acid for Vascular Outcome Reduction in Transplantation trial, we determined whether plasma levels of B-type natriuretic peptide (BNP) and cardiac troponin I are associated with adverse outcomes in stable kidney transplant recipients.
METHODSFive hundred ten subjects were selected randomly from the 4110 Folic Acid for Vascular Outcome Reduction in Transplantation participants. This cohort was then enriched for all additional subjects with adverse outcomes (death, dialysis-dependent kidney failure (DDKF), and cardiovascular outcomes) for a total of 1131 participants studied. Quartiles of BNP and high-sensitivity cardiac troponin I (hs-cTnI) were included in adjusted models. Combinations of normal and elevated hs-cTnI (>26.2 ng/L) and BNP (>100 pg/mL) were also studied.
RESULTSMedian concentrations (interquartile ranges) were 5.6 (3.3-10.5) ng/L for hs-cTnI and 39 (15, 94) pg/mL for BNP. Hazard ratios for each adverse outcome were higher with higher quartiles of BNP after adjustment and remained statistically significant after adding hs-cTnI to the model. The highest quartile hazard ratio for DDKF was 2.47 (95% confidence interval [95% CI], 1.21-5.05). Simultaneous elevations of BNP and hs-cTnI over clinical cutoffs were strongly associated with adverse outcomes with hazard ratios 8.8 (95% CI, 3.4-23.1) for DDKF and 6.3 (95% CI, 2.7-15.0) for cardiovascular outcomes.
CONCLUSIONSHigher BNP is associated with mortality and cardiovascular and kidney outcomes in stable kidney transplant recipients. Elevated BNP and hs-cTnI identify candidates for targeted risk reduction.