Cardiac troponin T predicts long-term outcomes in hemodialysis patients
D S Ooi1, D Zimmerman, J Graham
1Division of Biochemistry, Ottawa Hospital-Civic Campus, 1053 Carling Ave., Ottawa, ON K1Y 4E9 Canada. dsooi@ottawahospital.on.ca
Insights
Elevated cardiac troponin T (cTnT) in dialysis patients predicts higher mortality. Increasing cTnT levels over time also significantly increases the risk of death, particularly cardiac and sudden death.
Area of Science:
- Cardiology
- Nephrology
- Biomarkers
Background:
- Elevated plasma cardiac troponin T (cTnT), unlike troponin I (cTnI), is common in end-stage renal disease.
- Previous findings indicated a link between elevated cTnT and increased 12-month mortality in these patients.
Purpose of the Study:
- To investigate the long-term prognostic value of plasma cTnT in patients undergoing chronic hemodialysis.
- To correlate plasma cTnT levels and trends with patient outcomes, including mortality and vascular disease progression.
Main Methods:
- A cohort of 244 hemodialysis patients was followed for up to 34 months.
- Plasma cTnT levels from routine predialysis samples were analyzed.
- Longitudinal changes in cTnT were assessed in 97 patients with follow-up samples.
- Outcomes included all-cause mortality, cardiac events, cerebrovascular events, peripheral vascular disease, and neuropathy.
Main Results:
- Higher initial cTnT concentrations were associated with lower rates of kidney transplantation.
- Mortality rates (total and cardiac) significantly increased with higher baseline cTnT levels.
- Patients with increasing cTnT levels over time showed a 2.0-fold increased risk of death (P=0.028), primarily from cardiac and sudden causes.
Conclusions:
- Plasma cTnT is a significant predictor of long-term all-cause mortality in hemodialysis patients.
- This predictive value holds even for cTnT concentrations below 0.100 microg/L.
- A rising trend in cTnT concentration over time further elevates mortality risk.
Background:
Increased plasma troponin T (cTnT), but not troponin I (cTnI), is frequently observed in end-stage renal failure patients. Although generally considered spurious, we previously reported an associated increased mortality at 12 months.
Methods:
We studied long-term outcomes in 244 patients on chronic hemodialysis for up to 34 months, correlating the outcomes to plasma cTnT in routine predialysis samples. In addition, subsequent plasma samples at least 1 year later and within 6 months of data analysis were available in 97 patients and were used to identify patients with increasing plasma cTnT. The endpoints used were death and new or worsening coronary, cerebro-, and peripheral vascular disease and neuropathy.
Results:
Transplantation occurred more frequently in patients with low initial cTnT: 31%, 13%, and 3% in the groups with cTnT < 0.010, 0.010-0.099, and > or = 0.100 microg/L, respectively. In the same groups, total deaths occurred in 6%, 43%, and 59% and cardiac deaths in 0%, 14%, and 24% of patients. In patients with follow-up samples, the group with increasing cTnT had a significantly increased death (relative risk, 2.0; P = 0.028). The increase was mainly in cardiac and sudden deaths.
Conclusions:
Higher plasma cTnT predicts long-term all-cause mortality in hemodialysis patients, even at concentrations < 0.100 microg/L, as does an increasing cTnT concentration over time.
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:25Hemodialysis III: Nursing Management
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:28Chronic Kidney Disease III: Interprofessional Care
01:18Chronic Kidney Disease IV: Nursing Management