Prognostic Value of Serial Changes in High-Sensitivity Cardiac Troponin I and T over 3 Months Using Reference Change Values in Hemodialysis Patients

Abstract

INTRODUCTION:Serial changes in cardiac troponin in hemodialysis (HD) patients have uncertain clinical implications. We evaluated associations of adverse outcomes in HD patients with reference change value (RCV) data and tertile concentrations for cardiac troponin I (cTnI) and cTnT measured by high-sensitivity (hs) assays.

Renal Dysfunction Influences the Diagnostic and Prognostic Performance of High-Sensitivity Cardiac Troponin I

“…The 180-day mortality with respect to hs-cTnI by tertile (0-2.5 ng/ml [tertile 1; n=546], 2.5-10.6 ng/L [tertile 2; n=555], and .10.6 ng/L (tertile 3; n=539]) for all patients is shown in Figure 1. Mortality increased significantly with increasing 13,0.001 MI at presentation, high sensitivity, n (%) 167 (11) 49 750 (11) 41 18) (2110 13,0.001 MI at presentation, contemporary, n (%) 205 (13) 72 (10) 61 1446 20 hs-cTnI tertile: 1.3% (seven patients), 6.0% (33 patients), and 10.4% (56 patients), respectively (P,0.001 for tertile 1 versus 2 and tertile 1 versus 3 and P,0.01 for tertile 2 versus 3). The 180-day mortality with respect to hs-cTnI groups defined by concentrations less than limit of detection (LoD; n=445), LoD to less than sex-specific upper reference limits (URLs; n=886), and greater then sex-specific URLs (n=309) is shown in Figure 2.…”

“…5 Therefore, cTn testing may be expected to show lower clinical specificity for MI in the setting of CKD. 5,7,[11][12][13] Direct comparison with performance criteria reported in non-CKD populations is difficult due to the lack of consistency used for diagnostic cutoff concentrations and other population parameters between studies. Understanding the diagnostic performance of cTn testing in the setting of CKD is important for clinicians given that patients with CKD are at higher risk of developing cardiovascular disease than the general population and that cardiovascular disease is the leading cause of death in those patients with ESRD.…”

“…5 The literature shows the prognostic value of cTn testing in patients with CKD both with and without underlying acute coronary syndrome, showing that increased cTnI and cTnT concentrations are associated with greater risk of death and cardiac events in patients with renal disease than in those with normal renal function. 6,[11][12][13]16,17 Assessments of the diagnostic performance of cTn assays with renal impairment are less common, especially those addressing the more novel high-sensitivity assays that are increasingly used worldwide. 18 Two studies have shown that the diagnostic accuracy of high-sensitivity cardiac troponin T (hs-cTnT) for MI was significantly reduced in patients with renal dysfunction versus those with normal renal function.…”

Evaluation of the Relationship between Early Troponin Clearance and Short-Term Mortality in Patients with Chronic Renal Failure

“…A large number of studies have shown that in patients with end-stage renal disease (ESRD), both cTnI and cTnT are strong prognostic indicators for death of all causes and although cTnI increases less than cTnT, it is associated with a higher risk of mortality [17][18][19].…”

Chronic Kidney Disease and Arrhythmias: Conclusions From a Kidney Disease: Improving Global Outcomes (Kdigo) Controversies Conference

“…149 Troponins and brain natriuretic peptides could have an additive value and should be further explored to assess their role in a comprehensive risk assessment for SCD. [150][151][152][153] There are very limited data regarding the prognostic significance of incidentally detected arrhythmias in CKD and ESKD. Identification of episodes of non-sustained ventricular tachycardia, frequent premature ventricular complexes, bradyarrhythmias and pauses may be useful in identifying patients at risk of SCD.…”