Association of Cardiac Biomarkers With the Kansas City Cardiomyopathy Questionnaire in Patients With Chronic Kidney Disease Without Heart Failure.

Abstract

Background The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a measure of heart failure (HF) health status. Worse KCCQ scores are common in patients with chronic kidney disease (CKD), even without diagnosed heart failure (HF). Elevations in the cardiac biomarkers GDF-15 (growth differentiation factor-15), galectin-3, sST2 (soluble suppression of tumorigenesis-2), hsTnT (high-sensitivity troponin T), and NT-proBNP (N-terminal pro-B-type natriuretic peptide) likely reflect subclinical HF in CKD. Whether cardiac biomarkers are associated with low KCCQ scores is not known. Methods and Results We studied participants with CKD without HF in the multicenter prospective CRIC (Chronic Renal Insufficiency Cohort) Study. Outcomes included (1) low KCCQ score <75 at year 1 and (2) incident decline in KCCQ score to <75. We used multivariable logistic regression and Cox regression models to evaluate the associations between baseline cardiac biomarkers and cross-sectional and longitudinal KCCQ scores. Among 2873 participants, GDF-15 (adjusted odds ratio 1.42 per SD; 99% CI, 1.19-1.68) and galectin-3 (1.28; 1.12-1.48) were significantly associated with KCCQ scores <75, whereas sST2, hsTnT, and NT-proBNP were not significantly associated with KCCQ scores <75 after multivariable adjustment. Of the 2132 participants with KCCQ ≥75 at year 1, GDF-15 (adjusted hazard ratio, 1.36 per SD; 99% CI, 1.12-1.65), hsTnT (1.20; 1.01-1.44), and NT-proBNP (1.30; 1.08-1.56) were associated with incident decline in KCCQ to <75 after multivariable adjustment, whereas galectin-3 and sST2 did not have significant associations with KCCQ decline. Conclusions Among participants with CKD without clinical HF, GDF-15, galectin-3, NT-proBNP, and hsTnT were associated with low KCCQ either at baseline or during follow-up. Our findings show that elevations in cardiac biomarkers reflect early symptomatic changes in HF health status in CKD patients.

• Authors: Sri Lekha Tummalapalli, Leila R Zelnick, Amanda H Andersen, Robert H Christenson, Christopher R deFilippi, Rajat Deo, Alan S Go, Jiang He, Bonnie Ky, James P Lash, Stephen L Seliger, Elsayed Z Soliman, Michael G Shlipak, Nisha Bansal, CRIC Study Investigators †
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 9 Issue 13 Pg. e014385 (07 07 2020) ISSN: 2047-9980 [Electronic] England
• PMID: 32578483 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Blood Proteins
• GDF15 protein, human
• Galectins
• Growth Differentiation Factor 15
• LGALS3 protein, human
• Peptide Fragments
• Troponin T
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain

Topics

• Adult
• Aged
• Biomarkers (blood)
• Blood Proteins
• Cross-Sectional Studies
• Female
• Galectins (blood)
• Growth Differentiation Factor 15 (blood)
• Health Status Indicators
• Heart Failure (blood, diagnosis, epidemiology)
• Humans
• Incidence
• Longitudinal Studies
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Peptide Fragments (blood)
• Predictive Value of Tests
• Prognosis
• Prospective Studies
• Renal Insufficiency, Chronic (blood, diagnosis, epidemiology)
• Risk Assessment
• Risk Factors
• Surveys and Questionnaires
• Time Factors
• Troponin T (blood)
• United States (epidemiology)