Clinical Application of Cardiovascular Biomarkers in Chronic KidneyDisease

INTRODUCTION: Chronic kidney disease [CKD] is associated with an increased risk of cardiovascular complications, heart failure admission, chronic coronary artery disease, arrhythmias, and sudden cardiac death. The likelihood of this risk escalates with disease progression to more advanced stages. Therefore, early detection of cardiac disease, screening for risk factors, and implementing preventive and treatment options are essential in managing patients with advanced chronic renal disease. METHODS: Scale for the Assessment of Narrative Review Articles (SANRA)8 was applied to report this narrative review. Databases including PubMed (MEDLINE), Cochrane, EMBASE, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were searched for relevant papers published up to March 2025. Cohort studies and randomized clinical trials on cardiac biomarkers in chronic renal disease, including dialysis, were included in the review. RESULTS AND DISCUSSION: Traditional and novel biomarkers enhance understanding of cardiorenal dysfunction through insight into endothelial dysfunction, hemodynamic alterations, myocardial fibrosis, inflammation, and extracellular matrix remodeling, presenting opportunities for personalized risk assessment. The integration of multimarker strategies could improve prognostic accuracy compared to traditional risk scores alone. The interpretation of these biomarkers in CKD can be complex, since their elevation does not necessarily indicate pathophysiologic mechanisms leading to cardiovascular disease alone, but rather decreased urine clearance with retention of solutes and/or overall chronic inflammation associated with CKD. A key concern regarding the therapeutic usefulness of these markers arises from the lack of targeted research and validation in randomized trials. CONCLUSION: This article reviews both established traditional, non-traditional, and emerging laboratory biomarkers for the screening of cardiovascular disease in patients with CKD.