#4779 cardiac biomarkers for the prediction of incident major adverse cardiac events in patients starting haemodialysis: a real-world analysis

Abstract Background and Aims Despite its advantages, haemodialysis (HD) is associated with increased cardiovascular mortality and morbidity, with some studies reporting 48% higher mortality within 2 years of starting HD. Currently, there are no established prognostic models to stratify cardiovascular risk in incident HD. Cardiac biomarkers provide insight into cardiac structure and function, including myocyte injury, stress, inflammation and fibrosis. We aimed to investigate the prognostic significance of routine cardiac biomarkers (troponin and natriuretic peptides) in the prediction of incident Major Adverse Cardiovascular Events (MACE) within 5 years of commencing HD. Method A retrospective cohort study was performed using electronic medical records from a global federated research network from the US (TriNetX). The TriNetX network was searched on 31st January 2023. The cohorts commenced HD post-diagnosis of End-Stage Kidney Disease. Data censoring for MACE was invoked prior to the index event of HD. Cardiac biomarkers were the first reported result within 3 months of starting HD. Cohorts were grouped according to biomarker-specific thresholds and 1:1 propensity-score matched for age, gender, and co-morbidities (hypertension, diabetes mellitus and smoking status). Logistical regression produced odds ratios with 95%CI for 5-year incident MACE. MACE was defined, a priori, as a composite of ischaemic heart disease, angina pectoris, acute myocardial infarction, heart failure, AF, stroke, and all-cause mortality. All statistical analysis was performed on the TriNetX online platform. Results The results are shown in Table 1. Results that reached statistical significance (p<0.05) are shown. Conclusion Routinely available cardiac biomarkers can predict incident MACE and outcomes in incident HD, although results differ between markers of myocyte injury (troponin) and stress (NTproBNP). The results suggest the clinical need for CV mortality and morbidity risk profiling in incident dialysis using a combination of clinical and laboratory variables.