Universidad Autónoma de Madrid, Madrid, Spain.
Nat Rev Nephrol. 2011 Nov 1;8(3):141-50. doi: 10.1038/nrneph.2011.170.
Prognosis, risk stratification and monitoring the effects of treatment are fundamental elements in the decision-making process when implementing prevention strategies for chronic kidney disease. The use of biomarkers is increasingly proposed as a method to refine risk stratification and guide therapy. In this Review, we present basic concepts regarding the validation of biomarkers and highlight difficulties inherent to the identification of useful new biomarkers in patients on hemodialysis. We focus on prognostic biomarkers that have been consistently linked to survival in this group of patients. To date, no biomarker has had sufficient full-scale testing to qualify as a useful addition to standard prognostic factors or to guide the prescription of specific treatments in this population. Furthermore, little information exists on the relative strength of various biomarkers for their prediction of mortality. A multimarker approach might refine prognosis in patients on hemodialysis, but this concept needs to be properly evaluated in large longitudinal studies and clinical trials. The potential of proteomics for the identification and study of new biomarkers in the pathophysiology of cardiovascular disease in patients with end-stage renal disease is also discussed.
预后、风险分层和治疗效果监测是实施慢性肾脏病预防策略时决策过程的基本要素。生物标志物的应用越来越多地被提议作为一种细化风险分层和指导治疗的方法。在这篇综述中，我们介绍了生物标志物验证的基本概念，并强调了在血液透析患者中识别有用的新型生物标志物所固有的困难。我们重点介绍了与该组患者生存相关的预后生物标志物。迄今为止，还没有一种生物标志物经过充分的全面测试，足以被认为是标准预后因素的有用补充，或指导该人群的特定治疗。此外，关于各种生物标志物对死亡率预测的相对强度的信息很少。多标志物方法可能会细化血液透析患者的预后，但这一概念需要在大型纵向研究和临床试验中进行适当评估。本文还讨论了蛋白质组学在确定和研究终末期肾病患者心血管疾病病理生理学中的新型生物标志物方面的潜力。
