Predictive Value of Cardiac Troponin I and T for Subsequent Death in End-Stage Renal Disease

Abstract

Background-This study determined the prevalence of increased cardiac troponin I (cTnI) and T (cTnT) in end-stage renal disease (ESRD) patients and whether an increased troponin was predictive of death. Methods and Results-Serum was obtained from 733 ESRD patients and measured for cTnI and cTnT. Relative risks were estimated using Cox proportional hazards regressions univariately and adjusted for age, time on dialysis, and coronary artery disease. Kaplan-Meier curves compared time to event data between groups. Greater percentages of patients had an increased cTnT versus cTnI at each cutoff, as follows: 99th percentile, 82% versus 6%; 10% coefficient of variation, 53% versus 1.0%; and receiver operator characteristic, 20% versus 0.4%. Increased versus normal cTnT was predictive of increased mortality using all cutoffs and only above the 99th percentile for cTnI. Two-year cumulative mortality rates increased (PϽ0.001) with changes in cTnT from normal (Ͻ0.01 g/L, 8.4%) to small (Ն0.01 to Ͻ0.04 g/L, 26%), moderate (Ն0.04 to Ͻ0.1 g/L, 39%), and large (Ն0.1 g/L, 47%) increases. Two-year mortalities were 30% for cTnI Ͻ0.1 g/L and 52% if Ն0.1 g/L. Univariate and adjusted relative risks of death associated with elevated (Ͼ99th percentile) cTnT were 5.0 (CI, 2.5 to 10; PϽ0.001) and 3.9 (CI, 1.9 to7.9; PϽ0.001) and cTnI were 2.0 (CI, 1.3 to 3.3; Pϭ0.008) and 2.1 (CI, 1.3 to 3.3; Pϭ0.007). Age, coronary artery disease, and time on dialysis were also independent predictors of mortality. Conclusions-Increases in cTnT and cTnI in ESRD patients show a 2-to 5-fold increase in mortality, with a greater number of patients having an increased cTnT.

Use of clinically based troponin underestimates the cardiac injury in non-cardiac surgery: a single-centre cohort study in 51,701 consecutive patients

“…29 Further, we cannot comment on the etiology of the troponin elevations as troponin release is also associated with increased creatinine levels. 30,31 While these are important considerations, in our opinion, they do not explain our results. First, creatinine levels were elevated in \ 10% of the patients.…”

Role of Admission Troponin‐T and Serial Troponin‐T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock

“…Cardiac TnT and TnI have been previously evaluated in patients with renal disease including end‐stage renal disease, but further dedicated studies are needed to guide the interpretation of the individual troponin subtypes in patients with sepsis and kidney dysfunction 35, 36…”

Narrative Review: Alternative Causes for Elevated Cardiac Troponin Levels when Acute Coronary Syndromes Are Excluded

“…However, recent evidence demonstrates that troponin T is fragmented into molecules small enough to be renally excreted; this may explain the high prevalence of troponin elevation in patients with severe renal failure (48). Irrespective of the cause, detectable troponin among stable patients with end-stage renal disease appears to be a powerful predictor of increased intermediate-term mortality (44) and may be an even stronger risk factor in conjunction with elevated C-reactive protein levels (43). Of note, multivessel coronary artery disease was more prevalent across progressively higher quartiles of troponin T, suggesting an ischemic mechanism for the troponin increase in this patient population (43).…”