Cardiac Biomarkers in Chronic Kidney Disease

Cardiac biomarkers are circulating molecules released in response to myocardial stress or injury and are widely used in the diagnosis and prognosis of cardiovascular disease. In chronic kidney disease (CKD), impaired renal clearance and fluid overload can elevate concentrations of natriuretic peptides, cardiac troponins and emerging markers independent of intrinsic cardiac pathology. B-type natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP) reflect ventricular wall stretch, while high-sensitivity cardiac troponins indicate myocardial injury. Novel indicators such as copeptin, neutrophil gelatinase-associated lipocalin (NGAL) and growth differentiation factor-15 (GDF-15) offer insights into neurohormonal activation, tubular injury and systemic inflammation. Interpretation in CKD requires adjustment for glomerular filtration rate and volume status. Integration of these biomarkers into clinical pathways supports individualised risk stratification, timing of renal replacement therapy and the management of cardiorenal syndrome on a global scale.

Research from Nature Portfolio

Recent studies have shown that plasma BNP concentration independently predicts cardiovascular events and mortality in patients with CKD, even after accounting for standard cardiac parameters. In a large prospective cohort, individuals with BNP above 100 pg/mL experienced a significantly higher hazard of fatal or non-fatal cardiovascular outcomes over a median follow-up of 2.6 years. This finding underscores the utility of BNP as a powerful prognostic tool in early and moderate stages of CKD. Another investigation in chronic haemodialysis patients characterised age-stratified thresholds for NT-proBNP. The study revealed that younger patients exhibited lower optimal cut-off values for predicting all-cause and cardiovascular mortality, whereas in older patients substantially higher thresholds were required. These observations highlight the necessity for age-specific interpretative strategies when applying NT-proBNP in dialysis cohorts.

Cardiac Biomarkers in Chronic Kidney Disease publication trend

The graph below shows the total number of articles in cardiac biomarkers in chronic kidney disease across all publications each year (not limited to Nature Index journals).

Technical terms

B-type natriuretic peptide (BNP): A hormone released by ventricular myocardium in response to stretch, used to assess heart failure and volume overload.

N-terminal pro-B-type natriuretic peptide (NT-proBNP): An inactive fragment released alongside BNP, with longer half-life and similar diagnostic and prognostic value.

Estimated glomerular filtration rate (eGFR): A calculated index of kidney function that influences biomarker clearance and clinical interpretation.

Hazard ratio (HR): A measure of the relative risk of an event occurring in one group compared with another over time in survival analyses.

References

1. N-Terminal Pro-Brain Natriuretic Peptide Correlates with Ghrelin and Acyl-Ghrelin in Pre-Dialysis Chronic Kidney Disease. International Journal of Molecular Sciences (2024).
2. Plasma B-type natriuretic peptide is independently associated with cardiovascular events and mortality in patients with chronic kidney disease. Scientific Reports (2024).
3. NT-proBNP point-of-care testing for predicting mortality in end-stage renal disease: A survival analysis. Heliyon (2024).
4. Characterisation of N-terminal pro-brain natriuretic peptide in dialysis patients and its reduced prognostic significance in the elderly. Scientific Reports (2019).