Key result
Elevated baseline hs-TnT (Q4 vs Q1) was independently associated with a ≥40% decrease in eGFR in patients with type 2 diabetes mellitus (adjusted OR 5.63; 95% CI 3.49-9.10; P≤0.001).
Why the study?
Cardiac and inflammatory biomarkers may help identify patients with type 2 diabetes mellitus at high risk of worsening renal function.
Are baseline cardiac and inflammatory biomarkers associated with worsening renal outcomes in high-risk patients with type 2 diabetes mellitus?
Observational (n=12,310)
Are baseline cardiac and inflammatory biomarkers associated with worsening renal outcomes in high-risk patients with type 2 diabetes mellitus?
Odds Ratio: 5.63 (95% CI 3.49–9.1)
p-value: p=≤0.001
Elevated baseline levels of hs-TnT, NT-proBNP, and hs-CRP are independently associated with worsening renal function in high-risk patients with type 2 diabetes.
Elevated hs-TnT, NT-proBNP, and hs-CRP identify T2DM patients at higher renal risk; extends SAVOR-TIMI 53 data but leaves open whether biomarker-guided care improves outcomes.
BACKGROUND Cardiac and renal diseases commonly occur with bidirectional interactions. We hypothesized that cardiac and inflammatory biomarkers may assist in identification of patients with type 2 diabetes mellitus (T2DM) at high risk of worsening renal function. METHODS In this exploratory analysis from SAVOR-TIMI 53, concentrations of high-sensitivity cardiac troponin T (hs-TnT), N-terminal pro–B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hs-CRP) were measured in baseline serum samples of 12310 patients. The primary end point for this analysis was a ≥40% decrease in estimated glomerular filtration rate (eGFR) at end of treatment (EOT) at a median of 2.1 years. The relationships between biomarkers and the end point were modeled using adjusted logistic and Cox regression. RESULTS After multivariable adjustment including baseline renal function, each biomarker was independently associated with an increased risk of ≥40% decrease in eGFR at EOT [Quartile (Q) Q4 vs Q1: hs-TnT adjusted odds ratio (OR), 5.63 (3.49–9.10); NT-proBNP adjusted OR, 3.53 (2.29–5.45); hs-CRP adjusted OR, 1.84 (95% CI, 1.27–2.68); all P values ≤0.001]. Furthermore, each biomarker was independently associated with higher risk of worsening of urinary albumin-to-creatinine ratio (UACR) category (all P values ≤0.002). Sensitivity analyses in patients without heart failure and eGFR >60 mL/min provided similar results. In an adjusted multimarker model, hs-TnT and NT-proBNP remained significantly associated with both renal outcomes (all P values <0.01). CONCLUSIONS hs-TnT, NT-proBNP, and hs-CRP were each associated with worsening of renal function [reduction in eGFR (≥40%) and deterioration in UACR class] in high-risk patients with T2DM. Patients with high cardiac or inflammatory biomarkers should be treated not only for their risk of cardiovascular outcomes but also followed for renal deterioration.
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Zelniker et al. (2019) conducted an observational in Type 2 diabetes mellitus (n=12,310). Elevated baseline hs-TnT, NT-proBNP, and hs-CRP vs. Lowest quartile (Q1) of biomarkers was evaluated on ≥40% decrease in estimated glomerular filtration rate (eGFR) at end of treatment (OR 5.63, 95% CI 3.49-9.10, p=≤0.001). Elevated baseline hs-TnT (Q4 vs Q1) was independently associated with a ≥40% decrease in eGFR in patients with type 2 diabetes mellitus (adjusted OR 5.63; 95% CI 3.49-9.10; P≤0.001).
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