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Kislikova M, Gaitán-Valdizán JJ, Parra Blanco JA, García Unzueta MT, Rodríguez Vidriales M, Escagedo Cagigas C, Piñera Haces VC, Valentín Muñoz MDLO, Benito Hernández A, Ruiz San Millan JC, Rodrigo Calabia E. Looking into the Eyes to See the Heart of Chronic Kidney Disease Patients. Life (Basel) 2024; 14:533. [PMID: 38672803 PMCID: PMC11051204 DOI: 10.3390/life14040533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/03/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
In patients with chronic kidney disease (CKD), the main cause of morbidity and mortality is cardiovascular disease (CVD). Both coronary artery calcium scoring by computed tomography (CT) and optical coherence tomography (OCT) are used to identify patients at increased risk for ischemic heart disease, thereby indicating a higher cardiovascular risk profile. Our study aimed to investigate the utility of these techniques in the CKD population. In patients with CKD, OCT was used to measure the choroidal thickness (CHT) and the thickness of the peripapillary retinal nerve fiber layer (pRNFL). A total of 127 patients were included, including 70 men (55%) with an estimated glomerular filtration rate (eGFR) of 39 ± 30 mL/min/1.73 m2. Lower pRNFL thickness was found to be related to high-sensitivity troponin I (r = -0.362, p < 0.001) and total coronary calcification (r = -0.194, p = 0.032). In a multivariate analysis, pRNFL measurements remained associated with age (β = -0.189; -0.739--0.027; p = 0.035) and high-sensitivity troponin I (β = -0.301; -0.259--0.071; p < 0.001). Severe coronary calcification (Agatston score ≥ 400 HU) was related to a worse eGFR (p = 0.008), a higher grade of CKD (p = 0.036), and a thinner pRNFL (p = 0.011). The ROC curve confirmed that the pRNFL measurement could determine the patients with an Agatston score of ≥400 HU (AUC 0.638; 95% CI 0.525-0.750; p = 0.015). Our study concludes that measurement of pRNFL thickness using OCT is related to the markers associated with ischemic heart disease, such as coronary calcification and high-sensitivity troponin I, in the CKD population.
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Affiliation(s)
- Maria Kislikova
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital—IDIVAL, 39008 Santander, Spain; (M.R.V.); (C.E.C.); (V.C.P.H.); (M.d.l.O.V.M.); (A.B.H.); (J.C.R.S.M.); (E.R.C.)
| | | | | | | | - María Rodríguez Vidriales
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital—IDIVAL, 39008 Santander, Spain; (M.R.V.); (C.E.C.); (V.C.P.H.); (M.d.l.O.V.M.); (A.B.H.); (J.C.R.S.M.); (E.R.C.)
| | - Clara Escagedo Cagigas
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital—IDIVAL, 39008 Santander, Spain; (M.R.V.); (C.E.C.); (V.C.P.H.); (M.d.l.O.V.M.); (A.B.H.); (J.C.R.S.M.); (E.R.C.)
| | - Vicente Celestino Piñera Haces
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital—IDIVAL, 39008 Santander, Spain; (M.R.V.); (C.E.C.); (V.C.P.H.); (M.d.l.O.V.M.); (A.B.H.); (J.C.R.S.M.); (E.R.C.)
| | - María de la Oliva Valentín Muñoz
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital—IDIVAL, 39008 Santander, Spain; (M.R.V.); (C.E.C.); (V.C.P.H.); (M.d.l.O.V.M.); (A.B.H.); (J.C.R.S.M.); (E.R.C.)
| | - Adalberto Benito Hernández
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital—IDIVAL, 39008 Santander, Spain; (M.R.V.); (C.E.C.); (V.C.P.H.); (M.d.l.O.V.M.); (A.B.H.); (J.C.R.S.M.); (E.R.C.)
| | - Juan Carlos Ruiz San Millan
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital—IDIVAL, 39008 Santander, Spain; (M.R.V.); (C.E.C.); (V.C.P.H.); (M.d.l.O.V.M.); (A.B.H.); (J.C.R.S.M.); (E.R.C.)
| | - Emilio Rodrigo Calabia
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital—IDIVAL, 39008 Santander, Spain; (M.R.V.); (C.E.C.); (V.C.P.H.); (M.d.l.O.V.M.); (A.B.H.); (J.C.R.S.M.); (E.R.C.)
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Dudek M, Kałużna-Oleksy M, Migaj J, Sawczak F, Krysztofiak H, Lesiak M, Straburzyńska-Migaj E. sST2 and Heart Failure-Clinical Utility and Prognosis. J Clin Med 2023; 12:3136. [PMID: 37176577 PMCID: PMC10179304 DOI: 10.3390/jcm12093136] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
New parameters and markers are constantly being sought to help better assess patients with heart failure (HF). ST2 protein has gained interest as a potential biomarker in cardiovascular disease. It is known that the IL-33/ST2L system belongs to the cardioprotective pathway, which prevents the fibrosis, hypertrophy, and apoptosis of cardiomyocytes and also inhibits the inflammatory response. Soluble ST2 (sST2) is involved in the immune response and secreted in response to the mechanical overload of the myocardium, thus providing information on the processes of myocardial remodeling and fibrosis. A total of 110 hospitalized patients diagnosed with heart failure with reduced ejection fraction (HFrEF) were included in the study. Clinical and biochemical parameters were studied. During the follow-up, 30.9% patients died and 57.3% patients reached the composite endpoint. Using ROC curves, the reference cut-off point for sST2 was determined to be 45.818 pg/mL for all-cause deaths. Significantly higher concentrations of inflammatory parameters and natriuretic peptides were found in the group of patients with higher sST2 concentrations. sST2 protein is an independent risk factor for all-cause deaths of patients with HFrEF.
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Affiliation(s)
- Magdalena Dudek
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznań, Poland
| | - Marta Kałużna-Oleksy
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznań, Poland
| | - Jacek Migaj
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznań, Poland
| | - Filip Sawczak
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznań, Poland
| | - Helena Krysztofiak
- Department of Cardiology, University Hospital in Opole, 45-401 Opole, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznań, Poland
| | - Ewa Straburzyńska-Migaj
- 1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland
- Heliodor Swiecicki Clinical Hospital in Poznan, 60-355 Poznań, Poland
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Prognostic Value of Soluble Suppression of Tumorigenicity 2 in Chronic Kidney Disease Patients: A Meta-Analysis. DISEASE MARKERS 2021; 2021:8881393. [PMID: 33574967 PMCID: PMC7857877 DOI: 10.1155/2021/8881393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/31/2020] [Accepted: 01/14/2021] [Indexed: 01/11/2023]
Abstract
Objective Previous studies have controversial results about the prognostic role of soluble suppression of tumorigenicity 2 (sST2) in chronic kidney disease (CKD). Therefore, we conduct this meta-analysis to access the association between sST2 and all-cause mortality, cardiovascular disease (CVD) mortality, and CVD events in patients with CKD. Methods The publication studies on the association of sST2 with all-cause mortality, CVD mortality, and CVD events from PubMed and Embase were searched through August 2020. We pooled the hazard ratio (HR) comparing high versus low levels of sST2 and subgroup analysis based on treatment, continent, and diabetes mellitus (DM) proportion, and sample size was also performed. Results There were 15 eligible studies with 11,063 CKD patients that were included in our meta-analysis. Elevated level of sST2 was associated with increased risk of all-cause mortality (HR 2.05; 95% confidence interval (CI), 1.51-2.78), CVD mortality (HR 1.68; 95% CI, 1.35-2.09), total CVD events (HR 1.88; 95% CI, 1.26-2.80), and HF (HR 1.35; 95% CI, 1.11-1.64). Subgroup analysis based on continent, DM percentage, and sample size showed that these factors did not influence the prognostic role of sST2 levels to all-cause mortality. Conclusions Our results show that high levels of sST2 could predict the all-cause mortality, CVD mortality, and CVD events in CKD patients.
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de Cos Gomez M, Benito Hernandez A, Garcia Unzueta MT, Mazon Ruiz J, Lopez del Moral Cuesta C, Perez Canga JL, San Segundo Arribas D, Valero San Cecilio R, Ruiz San Millan JC, Rodrigo Calabia E. Growth Differentiation Factor 15: A Biomarker with High Clinical Potential in the Evaluation of Kidney Transplant Candidates. J Clin Med 2020; 9:E4112. [PMID: 33419237 PMCID: PMC7766056 DOI: 10.3390/jcm9124112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 12/20/2022] Open
Abstract
Kidney transplantation implies a significant improvement in patient survival. Nevertheless, early mortality after transplant remains high. Growth differentiation factor 15 (GDF-15) is a novel biomarker under study as a mortality predictor in multiple scenarios. The aim of this study is to assess the utility of GDF-15 to predict survival in kidney transplant candidates. For this purpose, 395 kidney transplant recipients with pretransplant stored serum samples were included. The median GDF-15 was 5331.3 (50.49-16242.3) pg/mL. After a mean of 90.6 ± 41.5 months of follow-up, 82 (20.8%) patients died. Patients with higher GDF-15 levels (high risk tertile) had a doubled risk of mortality after adjustment by clinical characteristics (p = 0.009). After adjustment by EPTS (Estimated Post Transplant Survival score) the association remained significant for medium hazards ratios (HR) 3.24 95%CI (1.2-8.8), p = 0.021 and high risk tertiles HR 4.3 95%CI (1.65-11.54), p = 0.003. GDF-15 improved the prognostic accuracy of EPTS at 1-year (ΔAUC = 0.09, p = 0.039) and 3-year mortality (ΔAUC = 0.11, p = 0.036). Our study suggests an independent association between higher GDF-15 levels and mortality after kidney transplant, adding accuracy to the EPTS score, an established risk prediction model currently used in kidney transplant candidates.
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Affiliation(s)
- Marina de Cos Gomez
- Nephrology Department, Hospital Universitario Marques de Valdecilla, Avenida Valdecilla n 5, 39724 Santander, Spain; (A.B.H.); (J.M.R.); (C.L.d.M.C.); (J.L.P.C.); (R.V.S.C.); (J.C.R.S.M.); (E.R.C.)
- Valdecilla Biomedical Research Institute (IDIVAL), Cardenal Herrera Oria S/N, 39011 Santander, Spain; (M.T.G.U.); (D.S.S.A.)
| | - Adalberto Benito Hernandez
- Nephrology Department, Hospital Universitario Marques de Valdecilla, Avenida Valdecilla n 5, 39724 Santander, Spain; (A.B.H.); (J.M.R.); (C.L.d.M.C.); (J.L.P.C.); (R.V.S.C.); (J.C.R.S.M.); (E.R.C.)
- Valdecilla Biomedical Research Institute (IDIVAL), Cardenal Herrera Oria S/N, 39011 Santander, Spain; (M.T.G.U.); (D.S.S.A.)
| | - Maria Teresa Garcia Unzueta
- Valdecilla Biomedical Research Institute (IDIVAL), Cardenal Herrera Oria S/N, 39011 Santander, Spain; (M.T.G.U.); (D.S.S.A.)
- Clinical Analysis Department, Hospital Universitario Marques de Valdecilla, Avenida Valdecilla n 5, 39724 Santander, Spain
| | - Jaime Mazon Ruiz
- Nephrology Department, Hospital Universitario Marques de Valdecilla, Avenida Valdecilla n 5, 39724 Santander, Spain; (A.B.H.); (J.M.R.); (C.L.d.M.C.); (J.L.P.C.); (R.V.S.C.); (J.C.R.S.M.); (E.R.C.)
- Valdecilla Biomedical Research Institute (IDIVAL), Cardenal Herrera Oria S/N, 39011 Santander, Spain; (M.T.G.U.); (D.S.S.A.)
| | - Covadonga Lopez del Moral Cuesta
- Nephrology Department, Hospital Universitario Marques de Valdecilla, Avenida Valdecilla n 5, 39724 Santander, Spain; (A.B.H.); (J.M.R.); (C.L.d.M.C.); (J.L.P.C.); (R.V.S.C.); (J.C.R.S.M.); (E.R.C.)
- Valdecilla Biomedical Research Institute (IDIVAL), Cardenal Herrera Oria S/N, 39011 Santander, Spain; (M.T.G.U.); (D.S.S.A.)
| | - Jose Luis Perez Canga
- Nephrology Department, Hospital Universitario Marques de Valdecilla, Avenida Valdecilla n 5, 39724 Santander, Spain; (A.B.H.); (J.M.R.); (C.L.d.M.C.); (J.L.P.C.); (R.V.S.C.); (J.C.R.S.M.); (E.R.C.)
- Valdecilla Biomedical Research Institute (IDIVAL), Cardenal Herrera Oria S/N, 39011 Santander, Spain; (M.T.G.U.); (D.S.S.A.)
| | - David San Segundo Arribas
- Valdecilla Biomedical Research Institute (IDIVAL), Cardenal Herrera Oria S/N, 39011 Santander, Spain; (M.T.G.U.); (D.S.S.A.)
- Clinical Immunology Department, Hospital Universitario Marques de Valdecilla, Avenida Valdecilla n 5, 39724 Santander, Spain
| | - Rosalia Valero San Cecilio
- Nephrology Department, Hospital Universitario Marques de Valdecilla, Avenida Valdecilla n 5, 39724 Santander, Spain; (A.B.H.); (J.M.R.); (C.L.d.M.C.); (J.L.P.C.); (R.V.S.C.); (J.C.R.S.M.); (E.R.C.)
- Valdecilla Biomedical Research Institute (IDIVAL), Cardenal Herrera Oria S/N, 39011 Santander, Spain; (M.T.G.U.); (D.S.S.A.)
| | - Juan Carlos Ruiz San Millan
- Nephrology Department, Hospital Universitario Marques de Valdecilla, Avenida Valdecilla n 5, 39724 Santander, Spain; (A.B.H.); (J.M.R.); (C.L.d.M.C.); (J.L.P.C.); (R.V.S.C.); (J.C.R.S.M.); (E.R.C.)
- Valdecilla Biomedical Research Institute (IDIVAL), Cardenal Herrera Oria S/N, 39011 Santander, Spain; (M.T.G.U.); (D.S.S.A.)
| | - Emilio Rodrigo Calabia
- Nephrology Department, Hospital Universitario Marques de Valdecilla, Avenida Valdecilla n 5, 39724 Santander, Spain; (A.B.H.); (J.M.R.); (C.L.d.M.C.); (J.L.P.C.); (R.V.S.C.); (J.C.R.S.M.); (E.R.C.)
- Valdecilla Biomedical Research Institute (IDIVAL), Cardenal Herrera Oria S/N, 39011 Santander, Spain; (M.T.G.U.); (D.S.S.A.)
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Homsak E, Gruson D. Soluble ST2: A complex and diverse role in several diseases. Clin Chim Acta 2020; 507:75-87. [PMID: 32305537 DOI: 10.1016/j.cca.2020.04.011] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 12/13/2022]
Abstract
The Suppression of Tumorigenicity 2 protein (ST2) is a member of the interleukin (IL) 1 receptor family with transmembrane (ST2L) and soluble (sST2) isoforms that are (over)expressed in several cells in different conditions and following various triggers (e.g. inflammation, stress). The ligand of ST2 is IL-33, which on binding to ST2L results in nuclear signalling and immunomodulatory action in various cells (tumour, immune, heart). sST2, that is released in the circulation, functions as a »decoy« receptor of IL-33 and inhibits IL-33/ST2L signalling and beneficial effects. The importance and role of the ST2/IL-33 axis and sST2 have been evaluated and confirmed in several inflammatory, cancer and cardiac diseases. sST2 is involved in homeostasis/pathogenesis of these diseases, as the counterbalance/response on IL-33/ST2L axis activation, which is triggered and expressed during developing fibrosis, tissue damage/inflammation and remodelling. In clinical studies, sST2 has been recognised as an important prognostic marker in patients with cardiac disease, including patients with chronic kidney disease where specific characteristics of sST2 enable better assessment of the risk of End-Stage Renal Disease patients on dialysis. sST2 is also recognised as an important marker for monitoring treatment in heart failure patients. However, accurate measurement and interpretation of ST2 concentration in serum/plasma samples for routine and research applications require the use of appropriate methods and recognition of essential characteristics of both the methods and the analyte that may influence the result. sST2, as one of the most promising disease biomarkers, is deserving of further study and wider application in clinical practice.
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Affiliation(s)
- Evgenija Homsak
- Department of Laboratory Diagnostics, University Medical Centre Maribor, Maribor, Slovenia.
| | - Damien Gruson
- Department of Laboratory Medicine, Cliniques Universitaires St-Luc and Universite Catholique de Lovain, Brussels, Belgium
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Devine PA, Cardwell C, Maxwell AP. Association of soluble ST2 with all-cause and cardiovascular mortality in renal transplant recipients: a single-centre cohort study. BMC Nephrol 2020; 21:22. [PMID: 31992225 PMCID: PMC6986045 DOI: 10.1186/s12882-020-1690-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/14/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Soluble ST2 is a novel biomarker of myocardial fibrosis with an established role in prognostication of patients with heart failure. Its role in cardiovascular risk prediction for renal transplant recipients has not been investigated despite promising results for ST2 in other populations with renal disease. METHODS In this prospective cohort study, 367 renal transplant recipients were followed up for a median of 16.2 years to investigate the association of soluble ST2 concentration with all-cause mortality. Cardiovascular mortality and major adverse cardiovascular events were secondary outcomes. Cox regression models were used to calculate hazard ratios and 95% confidence intervals for ST2 before and after adjustments. ST2 concentration was analysed both as a continuous variable and following categorisation according to the recommended cut-point of 35 ng/ml. RESULTS A twofold higher ST2 concentration was associated with a 36% increased risk of all-cause mortality after adjustment for conventional cardiovascular risk factors and high-sensitivity C-reactive protein (adjusted hazard ratio 1.36; 95% confidence interval 1.06-1.75; p = 0.016). Associations with ST2 concentration were similar for cardiovascular events (adjusted hazard ratio 1.31; 95% confidence interval 1.00-1.73; p = 0.054), but were stronger for cardiovascular mortality (adjusted hazard ratio 1.61; 95% confidence interval 1.07-2.41; p = 0.022). Addition of ST2 to risk prediction models for mortality and cardiovascular events failed to improve their predictive accuracy. CONCLUSIONS ST2 is associated with, but does not improve prediction of, adverse outcomes in renal transplant recipients.
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Affiliation(s)
- Paul A Devine
- Regional Nephrology and Transplant Unit, Belfast City Hospital, Belfast, UK.
- Centre for Public Health, Queen's University Belfast, Belfast, UK.
| | | | - Alexander P Maxwell
- Regional Nephrology and Transplant Unit, Belfast City Hospital, Belfast, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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sST2 as a New Biomarker of Chronic Kidney Disease-Induced Cardiac Remodeling: Impact on Risk Prediction. Mediators Inflamm 2018; 2018:3952526. [PMID: 30402040 PMCID: PMC6196921 DOI: 10.1155/2018/3952526] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/05/2018] [Indexed: 12/12/2022] Open
Abstract
Heart failure is the most frequent cardiac complication of chronic kidney disease (CKD). Biomarkers help identify high-risk patients. Natriuretic peptides (BNP and NT-proBNP) are largely used for monitoring patients with cardiac failure but are highly dependent on glomerular filtration rate (GFR). Soluble suppression of tumorigenicity 2 (sST2) biomarker is well identified in risk stratification of cardiovascular (CV) events in heart failure. Furthermore, sST2 is included in a bioclinical score to stratify mortality risk. The aims of this study were to evaluate (i) the interest of circulating sST2 level in heart dysfunction and (ii) the bioclinical score (Barcelona Bio-Heart Failure risk calculator) to predict the risk of composite outcome (major adverse coronary events) and mortality in the CKD population. A retrospective study was carried out on 218 CKD patients enrolled from 2004 to 2015 at Montpellier University Hospital. sST2 was measured by ELISA (Presage ST2® kit). GFR was estimated by the CKD-EPI equation (eGFR). Indices of cardiac parameters were performed by cardiac echography. No patient had reduced ejection fraction. 112 patients had left ventricular hypertrophy, and 184 presented cardiac dysfunction, with structural, functional abnormalities or both. sST2 was independent of age and eGFR (ρ = 0.05, p = 0.44, and ρ = −0.07, p = 0.3, respectively). Regarding echocardiogram data, sST2 was correlated with left ventricular mass index (ρ = 0.16, p = 0.02), left atrial diameter (ρ = 0.14, p = 0.04), and volume index (ρ = 0.13, p = 0.05). sST2 alone did not change risk prediction of death and/or CV events compared to natriuretic peptides. Included in the Barcelona Bio-Heart Failure (BCN Bio-HF) score, sST2 added value and better stratified the risk of CV events and/or death in CKD patients (p < 0.0001). To conclude, sST2 was associated with cardiac remodeling independently of eGFR, unlike other cardiac biomarkers. Added to the BCN Bio-HF score, the risk stratification of death and/or CV events in nondialyzed CKD patients was highly improved.
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