THE ASSOCIATION OF SERUM BIOMARKERS WITH SUBCLINICAL CARDIAC REMODELING IN EARLY STAGES OF CHRONIC KIDNEY DISEASE: A SYSTEMATIC REVIEW

Abstract

BACKGROUND: Patients with chronic kidney disease (CKD) have cardiovascular disease as the main cause of death, especially left ventricular hypertrophy, which can cause heart failure and ischemic heart disease. Cardiac remodeling occurs from the early and subclinical stages of the disease, but early diagnosis by conventional imaging methods is limited by cost and accessibility. In this context, serum biomarkers of cardiac injury, such as troponin and NT-proBNP, have emerged as tools for screening ventricular injury and hypertrophy in the early stages of CKD. OBJECTIVE: To evaluate the use of cardiac biomarkers in the screening of patients with CKD in the early stages. METHODS: A systematic review of the literature was carried out according to the technical standards of PRISMA. Articles were searched in the following databases: PubMed (via MEDLINE) and Cochrane. Studies dealing with advanced stages of CKD or patients on hemodialysis were excluded. Pediatric patient research or reviews were also excluded. RESULTS: Of the 635 articles found, only 6 met the pre-established criteria. A total of 9,648 patients, all of whom had CKD stages 1-3a. The biomarkers evaluated were: BN-terminal Natriuretic Peptide (NT-proBNP) and troponins. In the early stages of CKD, NT-proBNP consistently showed a greater ability to identify cardiac remodeling. It is more associated with interstitial fibrosis and diastolic dysfunction. While troponins are related to direct heart injury, edema, and increased left ventricular mass index, end-diastolic volume, but not ejection fraction or left atrial diameter.