HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Submit an electronic Letter to the Editor about this paper Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (6) Citing Articles via Google Scholar Google Scholar Articles by Cameron, S. J. Articles by Green, G. B. Search for Related Content PubMed PubMed Citation Articles by Cameron, S. J. Articles by Green, G. B. Related Collections Laboratory Management General Clinical Chemistry Evidence Based Laboratory Medicine and Test Utilization Proteomics and Protein Markers Lipids, Lipoproteins, and Cardiovascular Risk Factors

Cardiac Biomarkers in Renal Disease: The Fog Is Slowly Lifting

¹ Clinical Chemistry Division, Department of Pathology, and² Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD

^aAddress correspondence to this author at: Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 6-100, Baltimore, MD 21287. Fax 410-502-8881.

The first 300 words of the full text of this article appear below.

It has long been known that among patients with end-stage renal disease (ESRD), cardiac disease is the single greatest cause of mortality, accounting for nearly one half of all deaths (1). Among community-based populations, renal insufficiency is an independent predictor of the risk of subsequent ischemic heart disease, conferring a risk equivalent to that of diabetes (2). Furthermore, the presence of even moderate renal impairment in a patient presenting with an acute coronary syndrome (ACS) is a strong short-term prognostic indicator, significantly increasing the 30-day risk of myocardial infarction, heart failure, and cardiac death (3). Thus, a strong and pervasive link clearly exists between kidney failure and cardiac disease. The common challenge to the nephrologist, cardiologist, and emergency physician therefore lies in successfully recognizing those patients within their scope of practice who are most at risk, thereby allowing targeted application of interventions designed to circumvent adverse outcomes. Accordingly, there is an exigent need for the clinical laboratory to identify and make available reliable assays for biomarkers that can predict adverse events across a range of clinical settings and among patients with various degrees of kidney dysfunction, as well as to elucidate the performance characteristics and limitations of each of these markers.

A variety of individual biomarkers have previously been evaluated for this purpose, and several have been found to successfully predict outcome in patients with kidney disease. These include markers of myocardial necrosis, such as cardiac troponin T (cTnT) and I (cTnI) (4); markers of heart failure, such as B-type natriuretic peptide (BNP) and its associated inactive N-terminal fragment (NT-proBNP) (5); and the marker of systemic inflammation, high-sensitivity C-reactive protein (hsCRP) (6). However, fulfillment of the obvious potential of these biomarkers to have a positive impact on the . . . [Full Text of this Article]

The following articles in journals at HighWire Press have cited this article:

				U. Poge, T. M. Gerhardt, R. P. Woitas, C. Kragelund, L. Kober, and P. Hildebrandt N-Terminal Pro-B-Type Natriuretic Peptide and Mortality in Coronary Heart Disease N. Engl. J. Med., May 12, 2005; 352(19): 2025 - 2026. [Full Text] [PDF]

				G. Curhan Cystatin C: A Marker of Renal Function or Something More? Clin. Chem., February 1, 2005; 51(2): 293 - 294. [Full Text] [PDF]