#4789 routine cardiac biomarkers for the prediction of incident major adverse cardiac events in patients with glomerulonephritis: a real-world analysis

Abstract Background and Aims Patients with glomerulonephritis (GN) frequently have both proteinuria and decreased kidney function, and together with immunosuppressive therapies used to treat it could lend these patients to a high risk for cardiovascular disease (CVD). We aimed to investigate the prognostic significance of routine cardiac biomarkers (troponin) in predicting incident Major Adverse Cardiovascular Events (MACE) within 5 years of diagnosis of GN. 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. Data censoring for MACE was invoked prior to the index event of GN. Cardiac biomarkers were the first reported result within 3 months of diagnosis of GN. 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. The analysis was carried conducted by all-cause GN and individual primary GNs: IgA nephropathy (IgAN), membranous nephropathy (MN), focal segmental glomerulosclerosis (FSGS), and minimal change disease (MCD). All statistical analysis was performed on the TriNetX online platform. Results The results are shown below for all-cause GN. Results that reached statistical significance (p<0.05) are shown. The risk of MACE and its components was consistent across the individual GN sub-types IgAN (N = 1802), MN (N = 1674), FSGS (N = 1844) and MCD (N = 2014). Conclusion Routinely available cardiac biomarkers can predict incident MACE and outcomes in patients with glomerulonephritis. The results suggest the clinical need for CV mortality and morbidity risk profiling in patients with glomerular disease using a combination of clinical and laboratory variables.