Effect of renal function on serum cardiac troponin T--Population and individual effects
Jason Zhi Yong Chung1, Graham Ross Dallas Jones2
1Department of Chemical Pathology, SydPath, St Vincent's Hospital, Sydney, Victoria St, Darlinghurst, NSW 2010, Australia.
Insights
Cardiac troponin T (cTnT) elevations are linked to declining kidney function, even with moderate impairment. Interpreting cTnT levels requires caution in patients with chronic kidney disease (CKD).
Area of Science:
- Nephrology
- Cardiology
- Clinical Chemistry
Background:
- Elevated serum cardiac troponin T (cTnT) is observed in end-stage chronic kidney disease (CKD), but mechanisms remain unclear.
- Limited data exists on cTnT levels during short-term renal function changes or in milder renal impairment.
Purpose of the Study:
- To investigate the impact of changing renal function on cTnT levels within individuals.
- To characterize the distribution of cTnT in relation to renal function across a patient population.
Main Methods:
- Retrospective analysis of a hospital laboratory database for paired creatinine and cTnT results.
- Comparison of cTnT with estimated glomerular filtration rate (eGFR) at the population level.
- Analysis of changes in cTnT versus changes in creatinine in patients with repeat testing.
Main Results:
- A population-level inverse correlation was found between cTnT and eGFR (n=17,113), with no specific eGFR threshold.
- Moderate eGFR reduction (30-59 mL/min/1.73 m²) was associated with median cTnT above the upper reference limit (14 ng/L).
- Within-individual analysis (n=3108) showed cTnT changes approximated 33% of creatinine changes over a median of 15 hours.
Conclusions:
- Declining kidney function, even moderately, is associated with elevated cTnT levels.
- The modest short-term association between cTnT and creatinine changes underscores the need for careful interpretation of troponin elevations in patients with impaired renal function.
Background:
Elevations of serum cardiac troponin T (cTnT) have been described in patients with end stage chronic kidney disease (CKD) although the mechanism is unknown, whether from increased production or decreased clearance. Less is known about cTnT in short term changes in renal function and in lesser degrees of renal impairment.
Objectives:
This study aimed to investigate the effect of renal function changes on cTnT within individuals and characterise the distribution of cTnT according to renal function in the population.
Design And Methods:
A hospital laboratory database extract was performed for paired creatinine and cTnT results. cTnT was compared with estimated glomerular filtration rate (eGFR) at the population level. In individuals who had undergone repeat testing, changes in cTnT were compared with corresponding changes in creatinine.
Results:
At the population level, 17,113 cTnT and creatinine measurements from 10,418 patients demonstrated rising cTnT with falling eGFR, with no eGFR threshold for this effect. Of these, 3108 pairs of results were obtained from patients who had undergone repeat testing. The median retesting interval was 15 h (interquartile range: 7-25 h). Within individuals, the magnitude of changes in cTnT approximated 33% of changes in creatinine.
Conclusions:
At the population level, moderate reductions in GFR (30-59 mL/min/1.73 m(2)) corresponded to a median cTnT above the 14 ng/L upper reference limit. The modest association between changes in cTnT and creatinine within individuals in the short term further highlights the need for caution when interpreting troponin elevations in this setting.
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