High-sensitivity troponin T levels in kidney transplant recipients

Cardiovascular disease (CVD) is still the leading cause of death among kidney transplant recipients. Validated biomarkers are important to identify patients at high risk for cardiovascular events and mortality. Cardiac troponins are one of the best available prognostic markers in this clinical situation, especially in chronic kidney disease and kidney transplant (KT) patients. The recently appeared high-sensitivity immunoassay to measure troponin T (hsTnT) has not yet been widely studied in the transplant population. We designed a cross-sectional study to evaluate hsTnT levels among 177 stable, asymptomatic patients, including 44.1% (78) males of overall mean age of 56.14 ± 14.25 years. Mean glomerular filtration rate estimated with the MDRD-4 (eGFR MDRD) formula was 48.93 ± 26.46 mL/min/1.73 m(2). Median hsTnT was 11 (interquartile range = 11-26) ng/L. Patients were classified according to their hsTnT levels: normal, below 14 ng/L (57.6%, n = 102 patients), and those with basally elevated levels. Upon univariate analysis, a significant association was found between higher hsTnT levels and several variables, including clinical features, such as age, sex or prior CVD; renal function indicators: creatinine, eGFR MDRD, and proteinuria; nutritional and inflammation markers: albumin, ferritin, and C-reactive protein; and several cardiac enzymes: creatine kinase myocardial band (CKMB), B-type natriuretic peptide, and its N-terminal fragment. A logistic regression model adjusted for age, sex, and variables significantly associated with higher hsTnT levels, showed that male gender, age, CKMB, and lower glomerular filtration rate to show independent relation to basally elevated levels of hsTnT among asymptomatic kidney transplant recipients.