8.2 Monitoring using repeated biomarker measurement or imaging for management of chronic heart failure in people who also have chronic kidney disease Biomarkers are substances measurable in the blood stream which can be used to diagnose and monitor disease. Chronic kidney disease (CKD) develops when damage to the kidney results in reduced function. The extent of this damage can be approximated by blood tests to estimate glomerular filtration rate (GFR) from the kinetics of a stable excreted substance e.g. creatinine and a urine test to detect renal leakage of protein- usually albumin. The management of CKD is covered by NICE guideline CG182. Natriuretic peptides and troponin are raised in patients with HF and could potentially be used to guide treatment. However renal function can affect the level of biomarkers in the blood principally by affecting their clearance and this effect could influence their interpretation of biomarker results by clinicians. Imaging with echocardiography or cardiac MRI could be an alternative method of monitoring. The aim of this section of the review is to examine the clinical and cost-effectiveness of biomarker measurement or imaging in the management of heart failure in patients with CKD. 8.2.2 Review question: What is the clinical and cost effectiveness of biomarker-based monitoring, monitoring with cardiac MRI, and monitoring with repeated echocardiography in people with heart failure who also have CKD? For full details see review protocol in Appendix A. Chronic Heart Failure Monitoring NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Table 84: PICO characteristics of review question Population People diagnosed with heart failure in a community or outpatient setting who also have chronic kidney disease Aged under 75 years Aged 75 and over. 