Short communication| Volume 371, P402-405, January 15, 2023

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Performance of a multi-biomarker panel for prediction of cardiovascular event in patients with chronic kidney disease

Published:October 03, 2022DOI:


      • Patients with chronic kidney disease are at increased risk of cardiovascular events following coronary catheterization. Preceding coronary catheterization is an ideal time to measure biomarkers and estimate risk for future cardiovascular events.
      • Using a machine learning algorithm and targeted proteomics, we demonstrated that measuring four biomarkers (kidney injury molecule-1, N-terminal pro B-type natriuretic peptide, osteopontin, and tissue inhibitor of metalloproteinase-1) can individualize cardiovascular events risk assessment among patients with chronic kidney disease
      • Future clinical trials may assess the efficacy of implementing the HART CVE model in lowering cardiovascular events compared to the standard of care



      Patients with chronic kidney disease (CKD) undergoing coronary catheterization are at increased risk of cardiovascular events (CVE). Measuring biomarkers before the procedure may guide clinicians in identifying patients at higher risk of future cardiovascular events.


      In this sub-study the Catheter Sampled Blood Archive in Cardiovascular Diseases (CASABLANCA), 927 patients underwent coronary catheterization and were followed up for two years. Using machine learning algorithm and targeted proteomics from samples of patients with CKD, 4 biomarkers (kidney injury molecule-1, N-terminal pro B-type natriuretic peptide, osteopontin, and tissue inhibitor of metalloproteinase-1) were integrated into a prognostic algorithm to predict CVE. Results from the panel are expressed in a graded fashion (CVE higher risk and lower risk) using a data-driven cutoff optimized for balanced sensitivity and specificity.


      During the 2-year follow-up, 74 CVE were ascertained. 51 (rate: 51/378 = 13.5%) events occurred in stage 1–2 CKD and 23 (rate: 23/68 = 33.8%) events occurred in stage 3–5 CKD. The C-statistic for predicting 2-years cardiovascular events in all 446 patients was 0.77 (0.72, 0.82). The model was well-calibrated (Hosmer-Lemeshow test p-value >0.40). Considering patients at CVE lower-risk within each CKD staging group as a reference, the hazard ratio (95% confidence interval) of cardiovascular events was 2.82 (1.53, 5.22) for CKD stage 1–2/CVE higher-risk, and 8.32 (1.12, 61.76) for CKD stage 3–5/CVE higher-risk.


      Measuring biomarker panel prior to coronary catheterization may be useful to individualize CVE risk assessment among patients with CKD.

      Graphical abstract


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      Linked Article

      • Inflammation in chronic kidney disease – Something old, something new
        International Journal of CardiologyVol. 370
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          Chronic kidney disease (CKD) is a highly prevalent condition associated with significant levels of morbidity and mortality. Cardiovascular disease represents the single largest cause of mortality in chronic renal failure patients. In patients with renal disease, specific cardiovascular risk factors include secondary hyperparathyroidism, increased sympathetic-nerve activity, elevated levels of oxidized low-density lipoprotein and endothelial dysfunction characterized by elevated endothelin levels and diminished vascular nitric oxide production [1,2].
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