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  • Review Article
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Clinical usefulness of novel prognostic biomarkers in patients on hemodialysis

Nature Reviews Nephrology volume 8, pages 141–150 (2012)Cite this article

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Abstract

Prognosis, risk stratification and monitoring the effects of treatment are fundamental elements in the decision-making process when implementing prevention strategies for chronic kidney disease. The use of biomarkers is increasingly proposed as a method to refine risk stratification and guide therapy. In this Review, we present basic concepts regarding the validation of biomarkers and highlight difficulties inherent to the identification of useful new biomarkers in patients on hemodialysis. We focus on prognostic biomarkers that have been consistently linked to survival in this group of patients. To date, no biomarker has had sufficient full-scale testing to qualify as a useful addition to standard prognostic factors or to guide the prescription of specific treatments in this population. Furthermore, little information exists on the relative strength of various biomarkers for their prediction of mortality. A multimarker approach might refine prognosis in patients on hemodialysis, but this concept needs to be properly evaluated in large longitudinal studies and clinical trials. The potential of proteomics for the identification and study of new biomarkers in the pathophysiology of cardiovascular disease in patients with end-stage renal disease is also discussed.

Key Points

  • Novel biomarkers have the potential to refine risk stratification based on standard risk scores and to guide therapy in patients on hemodialysis

  • Biomarkers of chronic kidney disease-related mineral and bone disorders, protein–energy wasting, inflammation and myocardial injury or dysfunction have been linked with decreased survival

  • To date, no biomarker has had sufficient full-scale testing to qualify as a useful addition to standard prognostic factors or to guide therapy in patients on hemodialysis

  • A multimarker approach holds potential for refining prognosis in patients on hemodialysis, but this concept still needs to be properly evaluated in large cohorts and in clinical trials

  • Proteomics enables the simultaneous identification and evaluation of new biomarkers in the pathophysiology of established complications of kidney failure

  • Biomarkers can be applied to improve the design of clinical trials and to target specific subpopulations among patients on hemodialysis

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Figure 1: Gain in predictive power for mortality derived from the inclusion of individual and combined markers of inflammation.

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Authors and Affiliations

  1. Universidad Autónoma de Madrid, Madrid, Spain

    Alberto Ortiz

  2. University of Picardie Jules Verne, Amiens, France

    Ziad A. Massy

  3. Saarland University Medical Center, Homburg/Saar, Germany

    Danilo Fliser

  4. Karolinska Institutet, Stockholm, Sweden

    Bengt Lindholm

  5. Medical University of Silesia, Katowice, Poland

    Andrzej Wiecek

  6. Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain

    Alberto Martínez-Castelao

  7. C. I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania

    Adrian Covic

  8. Guy's and St Thomas' NHS Foundation Hospital, King's Health Partners, London, UK

    David Goldsmith

  9. Akdeniz University Medical School, Antalya, Turkey

    Gültekin Süleymanlar

  10. Hôpital Européen Georges Pompidou, Paris, France

    Gérard M. London

  11. Nephrology, Dialysis and Transplantation Unit and CNR-IBIM Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy

    Carmine Zoccali

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A. Ortiz and C. Zoccali researched data to include in the article. A. Ortiz, Z. A. Massy and C. Zoccali wrote the article. All authors contributed equally to discussion of content for the article and reviewing and editing of the manuscript before submission.

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Ortiz, A., Massy, Z., Fliser, D. et al. Clinical usefulness of novel prognostic biomarkers in patients on hemodialysis. Nat Rev Nephrol 8, 141–150 (2012). https://doi.org/10.1038/nrneph.2011.170

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