Comparison of Cardiac Biomarker Trends in Acute Kidney Injury versus Chronic Kidney Disease Patients with Acute Coronary Syndrome
Keywords:
Acute Coronary Syndrome, Acute Kidney Injury, Chronic Kidney Disease, Cardiac Biomarkers, NT-proBNPAbstract
Background: Cardiac biomarkers such as Troponin I, CK-MB, and NT-proBNP play a pivotal role in diagnosing and prognosticating acute coronary syndrome (ACS). However, their interpretation can be significantly influenced by underlying renal dysfunction, particularly in patients with acute kidney injury (AKI) or chronic kidney disease (CKD). The varying kinetics and clearance of these biomarkers in renal impairment pose a diagnostic challenge.
Aim: To compare the trends of cardiac biomarkers—Troponin I, CK-MB, and NT-proBNP—in patients with ACS having either AKI or CKD, and to evaluate the predictive factors influencing NT-proBNP levels.
Material and Methods: This prospective, comparative observational study was conducted in the Departments of Nephrology and Cardiology at a tertiary care teaching hospital. Sixty adult patients with ACS were enrolled and categorized into two groups: Group A (AKI, n=30) and Group B (CKD, n=30), based on KDIGO 2012 criteria and MDRD-based eGFR. Demographics, comorbidities, renal parameters, and serial cardiac biomarkers (at 0, 6, 12, and 24 hours) were recorded. Left ventricular function was assessed using echocardiography. Statistical analysis included t-tests, chi-square tests, repeated measures ANOVA, and multiple linear regression.
Results: Baseline demographics and comorbidities were comparable between the AKI and CKD groups. Serum creatinine and eGFR showed significant intergroup differences (p = 0.048 and p = 0.026, respectively). Troponin I and CK-MB levels followed a similar trend in both groups, peaking at 12 hours and declining by 24 hours, with no significant differences at any point. However, NT-proBNP levels were significantly higher in the CKD group at all time points (p < 0.001). Multivariate regression revealed CKD status, age, serum creatinine, Killip class ≥ II, and lower LVEF as significant predictors of NT-proBNP levels, with an adjusted R² of 0.65.
Conclusion: Troponin I and CK-MB exhibit comparable patterns in both AKI and CKD patients with ACS. In contrast, NT-proBNP levels are significantly elevated in CKD due to chronic volume overload and impaired clearance. CKD status was the strongest predictor of NT-proBNP elevation. Hence, cardiac biomarker interpretation in ACS must consider renal function for accurate risk stratification and management.
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Claure-Del Granado R, Chávez-Íñiguez JS. Renal Biomarkers in Cardiovascular Patients with Acute Kidney Injury: A Case Report and Literature Review. Diagnostics (Basel). 2023;13(11):1922. doi: 10.3390/diagnostics13111922.
Chavez-Iniguez JS, Sanchez-Villaseca SJ, Garcia-Macias LA. Cardiorenal syndrome: Classification, pathophysiology, diagnosis and management. Literature review. Arch Cardiol Mex. 2022;92(3):253–63. doi: 10.24875/ACME.M22000305.
Hatamizadeh P, Fonarow GC, Budoff MJ, Darabian S, Kovesdy CP, Kalantar-Zadeh K. Cardiorenal syndrome: Pathophysiology and potential targets for clinical management. Nat Rev Nephrol. 2013;9(2):99–111. doi: 10.1038/nrneph.2012.279.
Vandenberghe W, Gevaert S, Kellum JA, Bagshaw SM, Peperstraete H, Herck I, et al. Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis. Cardiorenal Med. 2016;6(2):116–28. doi: 10.1159/000442300.
Gigante A, Liberatori M, Gasperini ML, Sardo L, Di Mario F, Dorelli B, et al. Prevalence and clinical features of patients with the cardiorenal syndrome admitted to an internal medicine ward. Cardiorenal Med. 2014;4(2):88–94. doi: 10.1159/000362566.
Mavrakanas TA, Khattak A, Singh K, Charytan DM. Epidemiology and Natural History of the Cardiorenal Syndromes in a Cohort with Echocardiography. Clin J Am Soc Nephrol. 2017;12(10):1624–33. doi: 10.2215/CJN.04020417.
Boorsma EM, Ter Maaten JM, Voors AA, van Veldhuisen DJ. Renal Compression in Heart Failure: The Renal Tamponade Hypothesis. JACC Heart Fail. 2022;10(3):175–83. doi: 10.1016/j.jchf.2021.12.005.
Kashani K, Rosner MH, Ostermann M. Creatinine: From physiology to clinical application. Eur J Intern Med. 2020;72:9–14. doi: 10.1016/j.ejim.2019.10.025.
Claure-Del Granado R, Macedo E, Chavez-Iniguez JS. Biomarkers for Early Diagnosis of AKI: Could It Backfire? Kidney360. 2022;3(11):1780–4. doi: 10.34067/KID.0001012022.
Ostermann M, Zarbock A, Goldstein S, Kashani K, Macedo E, Murugan R, et al. Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference: A Consensus Statement. JAMA Netw Open. 2020;3(10):e2019209. doi: 10.1001/jamanetworkopen.2020.19209.
Moisi MI, Rus M, Bungau S, Zaha DC, Uivarosan D, Fratila O, et al. Acute Coronary Syndromes in Chronic Kidney Disease: Clinical and Therapeutic Characteristics. Medicina (Kaunas). 2020;56(3):118. doi: 10.3390/medicina56030118.
Chen YT, Jenq CC, Hsu CK, Chang CH, Lin CY, Chang MY, et al. Acute kidney disease and acute kidney injury biomarkers in coronary care unit patients. BMC Nephrol. 2020;21(1):207. doi: 10.1186/s12882-020-01872-z.
Chang CH, Yang CH, Yang HY, Chen TH, Lin CY, Chang SW, et al. Urinary biomarkers improve the diagnosis of intrinsic acute kidney injury in coronary care units. Medicine (Baltimore). 2015;94(40):e1703. doi: 10.1097/MD.0000000000001703.
Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52(19):1527–39. doi: 10.1016/j.jacc.2008.07.051.
Banerjee D, Perrett C, Banerjee A. Troponins, Acute Coronary Syndrome and Renal Disease: From Acute Kidney Injury Through End-stage Kidney Disease. EurCardiol. 2019;14(3):187–90. doi: 10.15420/ecr.2019.28.2.
Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD. Third universal definition of myocardial infarction. Glob Heart. 2012;7(4):275–95. doi: 10.1016/j.gheart.2012.08.001.
Ho KK, Anderson KM, Kannel WB, Grossman W, Levy D. Survival after the onset of congestive heart failure in Framingham heart study subjects. Circulation. 1993;88(1):107–15. doi: 10.1161/01.CIR.88.1.107.
Chen TH, Chang CH, Lin CY, Jenq CC, Chang MY, Tian YC, et al. Acute kidney injury biomarkers for patients in a coronary care unit: a prospective cohort study. PLoS One. 2012;7(2):e32328. doi: 10.1371/journal.pone.0032328.
Parikh CR, Mishra J, Thiessen-Philbrook H, Dursun B, Ma Q, Kelly C, et al. Urinary IL-18 is an early predictive biomarker of acute kidney injury after cardiac surgery. Kidney Int. 2006;70(1):199–203. doi: 10.1038/sj.ki.5001527.
Varshney A. A prospective study to assess the prevalence of anemia in school-going children. Journal of Advanced Medical and Dental Sciences Research. 2020 Oct 1;8(10):165-168.
Rawat R., Ram VS., Kumar G., Varshney A., Kumar M., Kumar P., Agrawal N. Awareness of general practitioners toward hypertension management. Journal of Pharmacy and Bioallied Sciences. 2021 Nov;13(Suppl 2):S1513-S1516.
Sachdeva A., Tiwari M.K., Shahid M., Varshney A. Unravelling the complex nexus: Adiposity, blood pressure, cardiac autonomic function, and arterial stiffness in young adults—An integrated analysis. Pakistan Heart Journal. 2023 May 11;56(2):215-219.
Varshney A., Singh R.P., Sachdeva A., Dayal A. A study of the incidence and significance of arrhythmias in the early and pre-discharged phase of acute myocardial infarction. European Journal of Molecular & Clinical Medicine. 2022;9(6):30-39.
Varshney A., Rawat R. Comparison of safety and efficacy of dapagliflozin and empagliflozin in type 2 diabetes mellitus patients in India. Revista Associação Médica Brasileira (1992). 2023 Aug 14;69(8):e20230090. doi: 10.1590/1806-9282.20230090.
Varshney A., Rawat R. A cross-sectional study of echocardiographic characteristics of patients diagnosed with SARS-CoV-2 delta strain. Global Cardiology Science & Practice. 2023;2023(3):e202319.
Varshney A., Agarwal N. Incidence of arrhythmias in COVID-19 patients with the double mutant strain of SARS-CoV-2 virus: A tertiary care experience. Global Cardiology Science & Practice. 2022;2022:E202216.
Varshney A., Ram VS., Kumar P. Beyond troponins: Emerging diagnostic significance of novel markers in NSTEMI. Global Cardiology Science & Practice. 2024 Aug 1;2024(4):e202433. doi: 10.21542/gcsp.2024.33.
Patel P., Mishra A., Gawande S.M., Patel A., Varshney A. Elevating expectations: Vericiguat in heart failure with reduced ejection fraction. Journal of Pharmacy and Bioallied Sciences. 2024;16(Suppl 4):S4010-S4012. doi: 10.4103/jpbs.jpbs_1392_24.
Varshney A., Kumar P., Ram V.S. Nonmotor symptoms and impulse control disorders in Parkinson’s disease patients in India: A cross-sectional study. Annals of African Medicine. 2024;23(3):400-405. doi: 10.4103/aam.aam_198_23.
Kumar G., Ram V.S., Kumar P., Mehray A., Varshney A. Study of electrocardiographic changes in normal subjects with or without family history of hypertension and type 2 diabetes mellitus in the context of visceral adiposity in Central India. Journal of Cardiovascular Disease Research. 2023;13(1):804-812.
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