Clinical usefulness of novel prognostic biomarkers in patients on hemodialysis

Universidad Autónoma de Madrid, Madrid, Spain.
Nature Reviews Nephrology (Impact Factor: 8.54). 11/2011; 8(3):141-50. DOI: 10.1038/nrneph.2011.170
Source: PubMed


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.

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    • "The recent developments in many research fields are leading to the discovery of prognostic biomarkers that could be suitable as risk indicator of pathologies (Berghella et al., 2014; Jenkins et al., 2011; Moore et al., 2006; Ortiz et al., 2011). Many biomarkers probably only exhibit a response in a part of the " health status space " (Allen and Moore, 2004; Depledge et al., 1993; Moore et al., 2006); where they will indicate that a reaction has taken place and may even indicate health status within a narrow range, or what has induced the response, but they do not generally indicate the health status of the whole range from healthy to irreversible damage (K€ ohler et al., 2002). "

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    • "Table 2 gives examples of the approved and clinically tested biomarkers for facilitating the prescription of a particular drug to specific patient subpopulation. Moreover, there are considerable interests in adopting the multimarker strategy for parallel evaluation of multiple existing and novel biomarkers in the diagnosis and prognostics of diseases and treatment responses in individual patients (34,35). These efforts may be facilitated by significantly expanding biomarker coverage in the biomarker databases. "
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