Divisions of Pediatrics, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
Department of Pediatrics, Karolinska University Hospital, Stockholm, Sweden.
Pediatr Nephrol. 2022 Dec;37(12):3165-3175. doi: 10.1007/s00467-022-05481-w. Epub 2022 Mar 16.
The N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitive cardiac-specific troponin T (hs-cTnT) are associated with abnormal cardiac structure and function and an increased risk of cardiovascular death in chronic kidney disease (CKD) patients. There is limited knowledge about these cardiac markers in pediatric CKD patients.
Longitudinal levels of NT-proBNP and hs-cTnT were analyzed in 48 pediatric patients, 22 with CKD (GFR range 8.8-68 mL/min/1.73 m) and 26 transplanted patients (CKD-T; GFR range 30-99 mL/min/1.73 m). Follow-up was scheduled after 1 and 3 years. Longitudinal patterns and associations to kidney function, cardiovascular risk markers, and echocardiographic parameters were assessed.
High NT-proBNP was present in 27% of CKD and 11% of CKD-T patients. Similarly 32% of CKD and 8% of CKD-T patients had elevated hs-cTnT levels. In longitudinal multivariate analyses, high log NT-proBNP was associated with low GFR (β = - 0.01, p = 0.01) and elevated left ventricular mass index (LVMI; β = 0.02, p = 0.05). The strong association to LVMI remained when using GFR-adjusted NT-proBNP in similar analysis. Patients with left ventricular hypertrophy (LVH) also had higher NT-proBNP (235 [146-301] ng/L) than patients without LVH (86 [11-477] ng/L), p = 0.02. High hs-cTnT over-time was also associated with low GFR (β = - 0.007, p = 0.01) and a low cc-TDI e´/a´, indicating a worse LV diastolic function (β = - 0.09, p = 0.05). This association did not persist for GFR-adjusted hs-cTnT.
NT-proBNP and hs-cTnT are elevated in pediatric CKD and CKD-T patients. GFR-adjusted NT-proBNP was associated with longitudinal levels of elevated LVMI suggesting this might be a marker for early subclinical myocardial damage. A higher resolution version of the Graphical abstract is available as Supplementary information.
N 端脑利钠肽前体（NT-proBNP）和高敏心肌肌钙蛋白 T（hs-cTnT）与慢性肾脏病（CKD）患者的心脏结构和功能异常以及心血管死亡风险增加有关。关于儿科 CKD 患者的这些心脏标志物的知识有限。
分析了 48 名儿科患者的 NT-proBNP 和 hs-cTnT 的纵向水平，其中 22 名患有 CKD（GFR 范围为 8.8-68 mL/min/1.73 m），26 名接受移植的患者（CKD-T；GFR 范围为 30-99 mL/min/1.73 m）。随访时间分别为 1 年和 3 年。评估了纵向模式以及与肾功能、心血管风险标志物和超声心动图参数的关系。
27%的 CKD 患者和 11%的 CKD-T 患者存在高 NT-proBNP。同样，32%的 CKD 患者和 8%的 CKD-T 患者的 hs-cTnT 水平升高。在纵向多变量分析中，高 log NT-proBNP 与低 GFR（β=-0.01，p=0.01）和左心室质量指数升高（LVMI；β=0.02，p=0.05）相关。在类似的分析中使用 GFR 校正的 NT-proBNP 时，与 LVMI 的强相关性仍然存在。左心室肥厚（LVH）患者的 NT-proBNP 也高于无 LVH 患者（235[146-301]ng/L 比 86[11-477]ng/L），p=0.02。hs-cTnT 随时间升高也与低 GFR（β=-0.007，p=0.01）和 cc-TDI e´/a´降低有关，表明左心室舒张功能较差（β=-0.09，p=0.05）。对于 GFR 校正的 hs-cTnT，这种相关性并不持续。
NT-proBNP 和 hs-cTnT 在儿科 CKD 和 CKD-T 患者中升高。GFR 校正的 NT-proBNP 与纵向升高的 LVMI 水平相关，表明这可能是早期亚临床心肌损伤的标志物。可提供高分辨率版本的图文摘要。
