PATHWAYS EXPLORED: CARDIOVASCULAR EVENTS IN PATIENTS WITH COEXISTING DIABETES AND CHRONIC KIDNEY DISEASE A SYSTEMATIC REVIEW OF BIOCHEMICAL AND INFLAMMATORY MARKERS
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Abstract
Diabetes mellitus (DM) and chronic kidney disease (CKD) synergistically increase the risk of cardiovascular events (CVEs) through intertwined metabolic, hemodynamic, and inflammatory pathways. Biochemical and inflammatory markers provide valuable insights into disease progression, risk stratification, and therapeutic targeting.
Objective: To systematically evaluate the prognostic and mechanistic roles of biochemical (e.g., NT-proBNP, high-sensitivity troponins, lipid profiles) and inflammatory (e.g., C-reactive protein, interleukin-6, tumor necrosis factor-α) markers in predicting cardiovascular outcomes among patients with coexisting DM and CKD.
Methods: Comprehensive searches of PubMed, Scopus, Web of Science, and Embase were conducted without year restrictions. Eligible studies included adult populations with both DM and CKD, reporting associations between biomarkers and CVEs. Data were synthesized narratively and, where possible, pooled in meta-analysis to assess effect estimates.
Results: Forty studies met inclusion criteria, encompassing over 230,000 participants. Elevated NT-proBNP and high-sensitivity cardiac troponins consistently predicted all-cause mortality, major adverse cardiovascular events (MACE), and hospitalization for heart failure. Inflammatory markers such as CRP, IL-6, and TNF-α were independently associated with accelerated atherosclerosis, left ventricular hypertrophy, and higher MACE incidence. Dyslipidemia, particularly elevated triglycerides and reduced HDL-C, correlated with increased ischemic events. Combined biomarker models outperformed single-marker approaches in risk prediction, especially when integrating renal function indices (eGFR, albuminuria).
Conclusion: Biochemical and inflammatory markers are integral to understanding and predicting cardiovascular risk in patients with DM and CKD. NT-proBNP and high-sensitivity troponins remain the most robust prognostic markers, while inflammatory cytokines add incremental predictive value. Incorporating multimarker strategies into routine risk assessment could enhance precision cardiovascular prevention in this high-risk population.
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Dr. Anoosh
MBBS, Bahria University Medical and Dental College, Karachi, Pakistan.
Dr. Priyanka Rani
MBBS, Ghulam Muhammad Mahar Medical College Sukkur / SMBBMU Larkana, Pakistan; Completed FCPS-2 Cardiology Training.
Dr. Huzaifa Hassan
MBBS, Karachi Institute of Medical Sciences (KIMS), Combined Military Hospital, Malir, Karachi, Pakistan.
Dr. Mehwish Qamar
MBBS (DUHS), FCPS Nephrology, Pakistan.
Dr. Hina Iram
MBBS, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan; FCPS Nephrology.
Dr. Syeda Malika Haider
BDS, MBA Healthcare & Hospital Management, CHPE, Jinnah Sindh Medical University, Karachi, Pakistan.
Dr. Amber Shams
MBBS, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan; Professional Diploma in Gynaecology & Obstetrics, Royal College of Physicians of Ireland (RCPI).