Renal Unit, "Magna Graecia", Department of Health Sciences, "Magna Graecia", University of Catanzaro, Italy, Catanzaro, Italy.
Renal Unit, University of Campania "Luigi Vanvitelli", Naples, Italy.
Biomed Res Int. 2020 Oct 8;2020:2314128. doi: 10.1155/2020/2314128. eCollection 2020.
Chronic kidney disease (CKD) is currently defined as the presence of proteinuria and/or an eGFR < 60 mL/min/1.73m on the basis of the renal diagnosis. The global dimension of CKD is relevant, since its prevalence and incidence have doubled in the past three decades worldwide. A major complication that occurs in CKD patients is the development of cardiovascular (CV) disease, being the incidence rate of fatal/nonfatal CV events similar to the rate of ESKD in CKD. Moreover, CKD is a multifactorial disease where multiple mechanisms contribute to the individual prognosis. The correct development of novel biomarkers of CV risk may help clinicians to ameliorate the management of CKD patients. Biomarkers of CV risk in CKD patients are classifiable as prognostic, which help to improve CV risk prediction regardless of treatment, and predictive, which allow the selection of individuals who are likely to respond to a specific treatment. Several prognostic (cystatin C, cardiac troponins, markers of inflammation, and fibrosis) and predictive (genes, metalloproteinases, and complex classifiers) biomarkers have been developed. Despite previous biomarkers providing information on the pathophysiological mechanisms of CV risk in CKD beyond proteinuria and eGFR, only a minority have been adopted in clinical use. This mainly depends on heterogeneous results and lack of validation of biomarkers. The purpose of this review is to present an update on the already assessed biomarkers of CV risk in CKD and examine the strategies for a correct development of biomarkers in clinical practice. Development of both predictive and prognostic biomarkers is an important task for nephrologists. Predictive biomarkers are useful for designing novel clinical trials (enrichment design) and for better understanding of the variability in response to the current available treatments for CV risk. Prognostic biomarkers could help to improve risk stratification and anticipate diagnosis of CV disease, such as heart failure and coronary heart disease.
慢性肾脏病(CKD)目前是基于肾脏诊断,定义为蛋白尿和/或 eGFR<60mL/min/1.73m 的存在。CKD 的全球范围很重要,因为在过去三十年中,其患病率和发病率在全球范围内翻了一番。CKD 患者的一个主要并发症是心血管(CV)疾病的发展,致命/非致命 CV 事件的发生率与 CKD 中的终末期肾病(ESKD)相似。此外,CKD 是一种多因素疾病,多种机制导致个体预后不同。新型 CV 风险生物标志物的正确开发可能有助于临床医生改善 CKD 患者的管理。CKD 患者的 CV 风险生物标志物可分为预后标志物,可帮助改善 CV 风险预测,而无需考虑治疗,以及预测性标志物,可选择可能对特定治疗有反应的个体。已经开发了几种预后(胱抑素 C、心脏肌钙蛋白、炎症和纤维化标志物)和预测(基因、金属蛋白酶和复杂分类器)生物标志物。尽管之前的生物标志物提供了有关 CKD 中 CV 风险的病理生理机制的信息,超出了蛋白尿和 eGFR,但只有少数被临床采用。这主要取决于生物标志物的结果不一致和缺乏验证。本综述的目的是介绍 CKD 中已经评估的 CV 风险生物标志物的最新进展,并检查在临床实践中正确开发生物标志物的策略。预测性和预后性生物标志物的开发是肾病学家的一项重要任务。预测性生物标志物可用于设计新的临床试验(富集设计),并更好地理解当前可用的 CV 风险治疗方法的反应变异性。预后性生物标志物可帮助改善风险分层,并预测 CV 疾病(如心力衰竭和冠心病)的诊断。
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