IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 17, Issue 3 Ver.13 March. (2018), PP 76-82 www.iosrjournals.org DOI: 10.9790/0853-1703137682 www.iosrjournals.org 76 | Page Prognostic Value of Cardiac Biomarkers in Hemodialysis Patients – which one to use? R. Koycheva 1 , M. Penev 1 , Sv. Staykova 2 1 Department of Internal medicine, Medical Faculty, Thracian University, Stara Zagora, Bulgaria 2 Clinic of Dialysis at University Hospital “St. Marina”- Varna, Bulgaria Abstract: The high prevalence of cardiovascular mortality in the end-stage renal disease population is well established. The aim of this current study was to document the relative prognostic significance of established biomarkers high-sensitive cardiac troponin T (hs cTnT), cardiac troponin I (cTnI), and N-terminal proBNP (NT-proBNP) and high-sensitive CRP (hs CRP) in this population. A prospective cohort study of dialysis patients undertaken in a single centre in Bulgaria. The relation between mortality and cardiac biomarkers was evaluated in 140 hemodialysis patients. End-point of interest was cardiac mortality. Statistical analysis using Cox proportional hazards was used to study relationship between competing covariates and outcome. Patients was followed upor a median duration of 24 months. The mean concentrations (+/-SEM) of hs cTnT, cTnI, NT- proBNP and hs CRP were 0,07±0,01 μg/L, 0,03±0,01 μg/L, 14969±1125 pg/mL and 16,4±2,38 mg/L respectively. Thirty-six subjects died during the period of follow up. By univariate analysis, cardiac markers hs cTnT, cTnI and NT-proBNP were significantly associated with an increase mortality. On Cox proportional hazards analysis, hs cTnT showed a highest significant association with cardiac mortality, with hazard ratios of 2,46, 95% confidence interval (CI) 1,39-4,33, p<0,002, followed by cTnI- 1,82, 95% CI1,41-2,34, p<0,0001 and NT-proBNP - 1,78, 95% CI 1,28-2,48, p<0,001 respectively. In patients with end-stage renal failure on dialysis hs cTnT provides greater prognostic information compared with NT-proBNP and cTnI. Keywords: cardiac biomarkers, hemodialysis, cardiac mortality -------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 12-03-2018 Date of acceptance: 28-03-2018 -------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Cardiovascular disease is the main cause of high mortality in hemodialysis patients. Elevations of cardiac troponins in asymptomatic hemodialysis patients are common and elevated cTnT has been associated with increased cardiac mortality in multiple studies [1-3]. The prevalence of elevated cTnI is lower compared with cTnT[4]. Cardiac troponins, which are released into the circulation and increased sharply if irreversible damage to the heart muscle exists [5]. There are other reasons for the presence of cTn. These are myocardial damage due to high pressure in the left ventricular wall in hypertrophy, acute or chronic volume overload, microvascular lesions, "quiet" subclinical myocardial ischemia fibrosis and necrosis. In hemodialysis patients, these conditions are very common [6]. N-terminal proBNP (NT-proBNP) is used as marker for congestive heart failure and is associated with left ventricular hypertrophy and systolic dysfunction in general population. B-type natriuretic peptide (BNP) is a hormone that is released in response to wall stretch of the cardiac ventricles. N- terminal proBNP (NT-proBNP) is an inactive fragment that is released along with BNP in a 1:1 ratio, cleared renally, and removed by hemodialysis (HD) to a very small extent [7]. The levels of both BNP and NT-proBNP are elevated in the ESRD population [7;8]. Elevation of this biomarker is high prevalent in dialysis population and is associated with increased mortality [9]. Elevated NT-proBNP in this population not only reflect wall stress, but also decreased renal clearance. The increased cardiovascular mortality is only partially explained by the presence of left ventricular hypertrophy and systolic dysfunction [10]. Moreover, there seems to be a complex interrelation with other biomarkers such as troponins and CRP. Elevations of hs CRP can be detected in this population such as in patients with chronic inflammation. Some studies report improved prognostic performance of these biomarkers when combined [11,12], whereas others do not [13]. The availability of these different biomarkers offers prognostic information that may be useful in various decision – making processes in hemodialysis patients, such as selecting patients for cardiovascular screening. The aim of this study was to investigate the performance of hs cTnT, cTnI, NT-proBNP and hs CRP to predict mortality in asymptomatic hemodialysis patients and interrelation between them.