Department of Nephrology, Clinic of Internal Medicine, University Medical Centre, Maribor, Slovenia.
Adv Clin Chem. 2012;57:29-56. doi: 10.1016/b978-0-12-394384-2.00002-4.
Patients with chronic kidney disease (CKD) are, compared to the general population, at higher risk of cardiovascular disease (CVD), including sudden death, coronary artery disease (CAD), congestive heart failure (HF), stroke, and peripheral artery disease. The presence of CVD is independently associated with kidney function decline. Renal insufficiency is a strong and independent predictor of mortality in patients with different CKD stages. The interplay of traditional and nontraditional risk factors is complex such that risk factor profiles are different in CKD patients. Seemingly, paradoxical associations between traditional risk factors and cardiovascular outcome complicate efforts to identify real cardiovascular etiology in these patients. Additional tools are often required to aid clinical assessment of cardiovascular risk. Recently, a number of cardiovascular biomarkers were identified as predictors of outcome in CVD. These may be used to guide early diagnosis and therapy for CVD or may predict outcome in CKD. This review focuses on the potential diagnostic and prognostic use of some important new biomarkers including brain natriuretic peptide (BNP), cardiac troponins (cTns), inflammatory markers, adhesion molecules, and asymmetric dimethylarginine (ADMA) in CKD as well as those patients with end-stage renal failure.
患有慢性肾病（CKD）的患者与普通人群相比，心血管疾病（CVD）的风险更高，包括猝死、冠心病（CAD）、充血性心力衰竭（HF）、中风和外周动脉疾病。CVD 的存在与肾功能下降独立相关。肾功能不全是不同 CKD 阶段患者死亡的强有力且独立的预测因素。传统和非传统危险因素的相互作用非常复杂，因此 CKD 患者的危险因素谱不同。传统危险因素与心血管结局之间似乎存在矛盾的关联，这使得在这些患者中确定真正的心血管病因变得复杂。通常需要额外的工具来帮助临床评估心血管风险。最近，一些心血管生物标志物被确定为 CVD 预后的预测因子。这些标志物可用于指导 CVD 的早期诊断和治疗，或预测 CKD 患者的结局。本文重点介绍了一些重要的新型生物标志物，包括脑钠肽（BNP）、心肌肌钙蛋白（cTns）、炎症标志物、黏附分子和不对称二甲基精氨酸（ADMA）在 CKD 以及终末期肾衰竭患者中的潜在诊断和预后价值。
