Cardiac Biomarkers in Chronic Kidney Disease: Signal or Noise?

Cardiac biomarkers can provide an easily accessible and noninvasive method of assessing aspects of a patients' underlying cardiovascular health. In doing so, they can serve both as a screening tool for evaluating patients' risk for cardiovascular events and a management tool for evaluating response to directed treatment. Biomarkers serve as surrogates for mechanistic pathways that are relevant for cardiovascular pathophysiology and, as such, have even been used as clinical trial end points. The overall utility of a biomarker is dependent on the reliability and consistency of the assay, the content of the represented information, and its ability to affect clinical care. Several cardiac biomarkers are widely available and routinely used in clinical practice. However, despite significant research into cardiac biomarkers, many have not been translated into routine clinical care of persons with CKD. Interpretation of cardiac biomarkers can be challenging given the possible effects of reduced kidney clearance as well as the contribution of kidney-specific risk facts on circulating levels of the biomarkers. Here, we will provide an overview of the current state of cardiac biomarkers in CKD and whether the biomarker meets the above criteria specifically in persons with CKD. We will focus on several widely used cardiac biomarkers ( N -terminal pro-B-type natriuretic peptide and troponin) as well as select newer promising cardiac biomarkers (soluble suppression of tumorigenicity 2, galectin-3, and growth differentiation factor-15).