Utility of Cardiac Troponins in Patients With Chronic Kidney Disease

Abstract

Cardiovascular disease is a major cause of death worldwide especially in patients with chronic kidney disease (CKD). Troponin T and troponin I are cardiac biomarkers used not only to diagnose acute myocardial infarction (AMI) but also to prognosticate cardiovascular and all-cause mortality. The diagnosis of AMI in the CKD population is challenging because of their elevated troponins at baseline. The development of high-sensitivity cardiac troponins shortens the time needed to rule in and rule out AMI in patients with normal renal function. While the sensitivity of high-sensitivity cardiac troponins is preserved in the CKD population, the specificity of these tests is compromised. Hence, diagnosing AMI in CKD remains problematic even with the introduction of high-sensitivity assays. The prognostic significance of troponins did not differ whether it is detected with standard or high-sensitivity assays. The elevation of both troponin T and troponin I in CKD patients remains strongly correlated with adverse cardiovascular and all-cause mortality, and the prognosis becomes poorer with advanced CKD stages. Interestingly, the degree of troponin elevation appears to be predictive of the rate of renal decline via unclear mechanisms though activation of the reninangiotensin and other hormonal/oxidative stress systems remain suspect. In this review, we present the latest evidence of the use of cardiac troponins in both the diagnosis of AMI and the prognosis of cardiovascular and all-cause mortality. We also suggest strategies to improve on the diagnostic capability of these troponins in the CKD/end-stage kidney disease population.

Association between YKL-40 and Cardiovascular Events in Hemodialysis Patients

“…The increase in troponin I levels in individuals with CKD is strongly associated with an increased risk of adverse cardiovascular events and higher overall mortality rates. Additionally, as CKD advances to more severe stages, the prognosis worsens (20) . Regarding YKL-40, this study showed a notable increase in HD patients with CVD compared to those without CVD and the control group.…”

Modern View on the Role of Sex-Specific Levels of High-Sensitive Cardiospecific Troponins T and I in the Diagnosis of Myocardial Infarction

“…The additional important diagnostic advantage of highsensitive tests for immunochemical determination of cardiospecific troponins is the ability to determine cardiac myocytes damage at the subclinical level, which can be used to monitor and assess the prognosis of patients suffering from a number of chronic pathologies, including coronary heart disease [37], during the treatment of oncological diseases by using chemotherapeutic compounds, which are characterized by cardiotoxicity [38][39][40], as well as chronic obstructive pulmonary disease [41,42], chronic kidney disease [43,44], diabetes mellitus [45], arterial hypertension [46], etc.…”

High-Sensitive Cardiospecific Troponins: The Role of Gender-Specific Concentration in the Diagnosis of Acute Coronary Syndrome (Descriptive Review)

“…The additional important diagnostic advantage of high-sensitive tests for immunochemical determination of cardiospecific troponins is the ability to determine cardiac myocytes damage at the subclinical level, which can be used to monitor and assess the prognosis of patients suffering from a number of chronic pathologies, including coronary heart disease [ 32 ], during the treatment of oncological diseases by using chemotherapeutic compounds, which are characterized by cardiotoxicity [ 33 ], as well as chronic obstructive pulmonary disease [ 34 ], chronic kidney disease [ 35 ], diabetes mellitus (DM) [ 36 ], arterial hypertension [ 37 ], etc.…”