Heart-type fatty acid-binding protein as a potential biomarker for hypertension in pediatric chronic kidney disease

Abstract Cardiovascular disease (CVD) is the leading cause of mortality in both adult and pediatric patients with chronic kidney disease (CKD). Hypertension is highly prevalent among pediatric CKD patients. This study aimed to investigate the association between heart-type fatty acid-binding protein (H-FABP) and the presence of hypertension in this population. A total of 231 pediatric patients diagnosed with CKD and admitted to the Department of Nephrology between January and June 2024 in Children’s Hospital of Fudan University were enrolled. Serum levels of H-FABP were measured, and relevant laboratory results along with clinical characteristics were collected for analysis. The overall prevalence of hypertension in pediatric CKD was 49.35% in the study. Serum levels of H-FABP, high-sensitivity cardiac troponin I (hs-cTnI), soluble suppression of tumorigenicity-2 (sST2) and myoglobin (Myo) were significantly elevated in patients with CKD and hypertension compared to those with CKD but without hypertension ( P < 0.001). All four biomarkers exhibited negative correlations with estimated glomerular filtration rate (eGFR) ( P < 0.05). Notably, H-FABP demonstrated the strongest negative correlation ( r = -0.885, P < 0.001). Additionally, H-FABP levels were positively correlated with hs-cTnI, sST2, Myo, creatine kinase-MB, serum creatinine, urinary albumin-to-creatinine ratio, total cholesterol, triglycerides, and low-density lipoprotein ( P < 0.05). Multivariate logistic regression analysis, adjusted for clinical variables and CKD-related biomarkers including Myo and hs-cTnI, confirmed H-FABP as an independent risk factor for hypertension (OR: 1.12; 95% CI: 1.05–1.20; P < 0.001). Receiver operating characteristic curve analysis revealed that the clinical model had strong discriminatory power for identifying pediatric CKD patients with hypertension (AUC = 0.837, P < 0.001). Subgroup analyses using multivariate logistic regression also revealed that H-FABP was associated with hypertension in CKD patients stratified by different etiologies, including CAKUT, non-CAKUT, and glomerular diseases. Our findings preliminarily identify H-FABP as a potential biomarker for hypertension risk in the pediatric CKD population.