BACKGROUND: The Canadian Study of Prediction of Death, Dialysis and Interim 
Cardiovascular Events (CanPREDDICT) is a large, prospective, pan-Canadian, 
cohort study designed to improve our understanding of determinants of renal and 
cardiovascular (CV) disease progression in patients with chronic kidney disease 
(CKD). The primary objective is to clarify the associations between traditional 
and newer biomarkers in the prediction of specific renal and CV events, and of 
death in patients with CKD managed by nephrologists. This information could then 
be used to better understand biological variation in outcomes, to develop 
clinical prediction models and to inform enrolment into interventional studies 
which may lead to novel treatments.
METHODS/DESIGNS: Commenced in 2008, 2546 patients have been enrolled with eGFR 
between 15 and 45 ml/min 1.73m2 from a representative sample in 25 rural, urban, 
academic and non academic centres across Canada. Patients are to be followed for 
an initial 3 years at 6 monthly intervals, and subsequently annually. 
Traditional biomarkers include eGFR, urine albumin creatinine ratio (uACR), 
hemoglobin (Hgb), phosphate and albumin. Newer biomarkers of interest were 
selected on the basis of biological relevance to important processes, commercial 
availability and assay reproducibility. They include asymmetric dimethylarginine 
(ADMA), N-terminal pro-brain natriuretic peptide (NT-pro-BNP), troponin I, 
cystatin C, high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL6) and 
transforming growth factor beta 1 (TGFβ1). Blood and urine samples are collected 
at baseline, and every 6 monthly, and stored at -80°C. Outcomes of interest 
include renal replacement therapy, CV events and death, the latter two of which 
are adjudicated by an independent panel.
DISCUSSION: The baseline distribution of newer biomarkers does not appear to 
track to markers of kidney function and therefore may offer some discriminatory 
value in predicting future outcomes. The granularity of the data presented at 
baseline may foster additional questions.The value of the cohort as a unique 
resource to understand outcomes of patients under the care of nephrologists in a 
single payer healthcare system cannot be overstated. Systematic collection of 
demographic, laboratory and event data should lead to new insights. The mean age 
of the cohort was 68 years, 90% were Caucasian, 62% were male, and 48% had 
diabetes. Forty percent of the cohort had eGFR between 30-45 mL/min/1.73m², 22% 
had eGFR values below 20 mL/min/1.73m²; 61% had uACR < 30. Serum albumin, 
hemoglobin, calcium and 25-hydroxyvitamin D (25(OH)D) levels were progressively 
lower in the lower eGFR strata, while parathyroid hormone (PTH) levels 
increased. Cystatin C, ADMA, NT-proBNP, hsCRP, troponin I and IL-6 were 
significantly higher in the lower GFR strata, whereas 25(OH)D and TGFβ1 values 
were lower at lower GFR. These distributions of each of the newer biomarkers by 
eGFR and uACR categories were variable.