Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Renal Disease
Multimarker Approach to Risk Stratification for Long-Term Mortality in Patients on Chronic Hemodialysis
Junnichi IshiiHiroshi TakahashiFumihiko KitagawaAtsuhiro KunoRyuunosuke OkuyamaHideki KawaiTakashi MuramatsuHiroyuki NaruseSadako MotoyamaShigeru MatsuiMidori HasegawaToru AoyamaDaisuke KamoiHirotake KasugaHideo IzawaYukio OzakiYukio Yuzawa
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2015 Volume 79 Issue 3 Pages 656-663

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Abstract

Background:We prospectively investigated the prognostic value of the combined use of cardiac troponin T (TnT), B-type natriuretic peptide (BNP), and high-sensitivity C-reactive protein (CRP) for long-term mortality in hemodialysis (HD) patients.Methods and Results:Baseline measurements of TnT, BNP, and CRP were performed in 516 patients on chronic HD. Patients were followed up for 10 years. Using the Cox multivariate model with these 3 biomarkers as variables categorized into tertiles for mortality, a simplified score was obtained by underscoring individual biomarkers based on the adjusted hazard ratio (HR). The multimarker score was defined as the sum of these points. TnT, BNP, and CRP levels were individually independent predictors for mortality (P<0.05). Among low-risk (multimarker score <4), intermediate-risk (multimarker score 4–7), and high-risk (multimarker score ≥7) groups, 10-year survival rates were 83.3%, 54.3%, and 27.2% (P<0.0001), respectively. After adjusting for other confounders, the multimarker score had strong predictive power for mortality (HR: 4.26; P<0.0001 for high-risk vs. low-risk group). Furthermore, adding the multimarker score to a baseline model with established risk factors improved the C-index (P<0.01), net reclassification improvement (P<0.0001), and integrated discrimination improvement (P<0.0001) greater than that of any single biomarker or baseline model alone.Conclusions:The multimarker approach (ie, simultaneous assessment of TnT, BNP, and CRP, which individually independently predict prognosis) may improve the prediction of long-term mortality in HD patients. (Circ J 2015; 79: 656–663)

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© 2015 THE JAPANESE CIRCULATION SOCIETY
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