Secretoneurin is not associated with cardiovascular events or mortality in patients treated with hemodialysis: A prospective multicenter cohort study

INTRODUCTION: Secretoneurin (SN) is a novel cardiac biomarker with an upper reference limit of ∼60 pmol/L in healthy individuals. High SN concentrations have been associated with an increased risk of mortality in various cardiac diseases. We investigated the association between SN and the risk of cardiovascular (CV) events and all-cause mortality in patients treated with maintenance hemodialysis (HD).

MATERIALS AND METHODS: Prospective multicenter cohort study with five years of follow-up. Serum SN (pmol/L) was measured at baseline. Outcomes were CV events (composite outcome) and all-cause mortality. The population was divided into tertiles according to SN concentrations: tertile 1 < 110.7 pmol/L, tertile 2 110.7-143 pmol/L, and tertile 3 > 143 pmol/L. The association between SN tertiles and outcomes was examined using Cox regression analysis.

RESULTS: The study included 336 patients treated with HD. Median SN concentration was 126 (100-153) pmol/L. During a median follow-up of 5.05 (5.02-5.07) years, 42 % had a CV event and 60 % died. Despite overall high SN concentrations, neither SN tertile 2 nor SN tertile 3 was associated with the risk of CV events (HRtertile2 1.27 (95 % CI 0.84-1.93) and HRtertile3 1.20 (95 % CI 0.76-1.90)) or all-cause mortality (HRtertile2 0.84 (95 % CI 0.60-1.18) and HRtertile3 0.90 (95 % CI 0.62-1.31)), when compared to tertile 1.

CONCLUSIONS: Patients treated with HD have high SN concentrations; however, SN was not associated with CV events or all-cause mortality after five years of follow-up. High concentrations of SN, possibly explained by both impaired renal clearance and a high prevalence of cardiomyopathy, may limit its prognostic relevance in patients treated with maintenance HD.