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Association Between Cardiac Biomarkers and the Development of ESRD in Patients With Type 2 Diabetes Mellitus, Anemia, and CKD  Akshay S. Desai, MD, MPH,

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Presentation on theme: "Association Between Cardiac Biomarkers and the Development of ESRD in Patients With Type 2 Diabetes Mellitus, Anemia, and CKD  Akshay S. Desai, MD, MPH,"— Presentation transcript:

1 Association Between Cardiac Biomarkers and the Development of ESRD in Patients With Type 2 Diabetes Mellitus, Anemia, and CKD  Akshay S. Desai, MD, MPH, Robert Toto, MD, Petr Jarolim, MD, PhD, Hajime Uno, PhD, Kai-Uwe Eckardt, MD, Reshma Kewalramani, MD, Andrew S. Levey, MD, Eldrin F. Lewis, MD, MPH, John J.V. McMurray, MD, Hans-Henrik Parving, MD, Scott D. Solomon, MD, Marc A. Pfeffer, MD, PhD  American Journal of Kidney Diseases  Volume 58, Issue 5, Pages (November 2011) DOI: /j.ajkd Copyright © 2011 National Kidney Foundation, Inc. Terms and Conditions

2 Figure 1 Proportion of patients with detectable troponin T (TnT; ≥0.01 ng/mL) stratified by quartiles of baseline estimated glomerular filtration rate (eGFR) at baseline and by baseline urine protein-creatinine ratio <1 versus ≥1 g/g. Error bars represent 95% confidence intervals. American Journal of Kidney Diseases  , DOI: ( /j.ajkd ) Copyright © 2011 National Kidney Foundation, Inc. Terms and Conditions

3 Figure 2 Median values of N-terminal pro–brain natriuretic peptide (NT-pro-BNP) stratified by quartiles of estimated glomerular filtration rate (eGFR) at baseline and baseline urine protein-creatinine ratio <1 versus ≥1 g/g. Error bars represent 95% confidence intervals. American Journal of Kidney Diseases  , DOI: ( /j.ajkd ) Copyright © 2011 National Kidney Foundation, Inc. Terms and Conditions

4 Figure 3 Unadjusted cumulative incidence of end-stage renal disease (ESRD) stratified by troponin T (TnT; detectable vs undetectable) and N-terminal pro–brain natriuretic peptide (BNP; above or below the median) values. Also presented are annualized event rates and hazard ratios (HRs) associated with each curve. Abbreviation: CI, confidence interval. American Journal of Kidney Diseases  , DOI: ( /j.ajkd ) Copyright © 2011 National Kidney Foundation, Inc. Terms and Conditions

5 Figure 4 Unadjusted Kaplan-Meier curves for death or end-stage renal disease (ESRD) stratified by troponin T (TnT; detectable vs undetectable) and N-terminal pro–brain natriuretic peptide (BNP; above or below the median) values. Also presented are annualized event rates and hazard ratios (HRs) associated with each curve. Abbreviation: CI, confidence interval. American Journal of Kidney Diseases  , DOI: ( /j.ajkd ) Copyright © 2011 National Kidney Foundation, Inc. Terms and Conditions

6 Figure 5 Improvement in net reclassification for end-stage renal disease (ESRD) with the addition of cardiac biomarker levels to the TREAT (Trial to Reduce Cardiovascular Events With Aranesp Therapy) model. Top and bottom panels depict predicted risk scores before and after the addition of cardiac biomarker levels for participants with and without an ESRD event in TREAT, respectively. Blue dots represent participants for whom the risk score moved in the correct direction after the addition of biomarkers (ie, up for patients with an event and down for patients without an event), whereas black dots represent participants for whom the risk score moved in the wrong direction. Because 50% of participants could be reclassified merely by the play of chance, net reclassification improvement represents the proportion of patients >50% who were reclassified in the appropriate direction. Here, the risk score increased in 67.1%-50% = 17.1% of those with an event and decreased in 49.7%-50% = −0.3% of those without an event. Net reclassification improvement therefore is 17.1%-0.3% = 16.8% (16.9% without rounding before subtraction; 95% confidence interval, 6.3%-27.4%). American Journal of Kidney Diseases  , DOI: ( /j.ajkd ) Copyright © 2011 National Kidney Foundation, Inc. Terms and Conditions


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