Cardiac Troponins and Renal Function in Nondialysis Patients with Chronic Kidney Disease

Abbas, Nasir; John, R. Ian; Webb, Michelle; Kempson, Michelle E.; Potter, Aisling N.; Price, Christopher P.; Vickery, Susan; Lamb, Edmund J.

doi:10.1373/clinchem.2005.055665

Cited by 152 publications

(131 citation statements)

References 44 publications

(46 reference statements)

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“…[7][8][9][10][11][12][13][14] Studies of patients with reduced eGFR and an acute coronary syndrome or presenting to an emergency room with chest pain also showed an increased risk of death in those with an elevated cTnT compared with a cTnT below the established necrosis limit. [15][16][17] Older studies typically defined an elevated cTnT as $0.09 ng/ml and found roughly a 2.6-fold increased risk of death in those with an elevated cTnT. We found an approximately 1.5-fold increase in the risk of death in patients with an eGFR,30 ml/min per 1.73 m 2 .…”

Section: Discussionmentioning

confidence: 50%

Kidney Function Alters the Relationship between Postoperative Troponin T Level and Death

Walsh

Wang²,

Ong³

et al. 2015

Journal of the American Society of Nephrology

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Cardiac troponin T (cTnT), even at low concentrations, is a risk factor for 30-day mortality in patients undergoing noncardiac surgery, but it is uncertain whether that risk is generalizable to patients with poor kidney function. We, therefore, evaluated the relationship between cTnT concentration and kidney function on the outcome of 30-day mortality in a post hoc analysis of a prospective cohort study of patients undergoing noncardiac surgery. cTnT was measured for 3 days after surgery and considered abnormal if the peak was $0.02 ng/ml. Of the included 14,037 patients, 267 (1.9%) patients died within 30 days of surgery. The adjusted hazard ratios for death with an abnormal cTnT concentration were 4.37 (95% confidence intervals [95% CI], 3.21 to 6.22), 6.15 (95% CI, 2.95 to 140.9), 6.30 (95% CI, 3.12 to 21.23), 1.33 (95% CI, 0.56 to 4.85), and 1.46 (95% CI, 0.46 to 9.21) for eGFR$60, 45 to ,60, 30 to ,45, 15 to ,30, and ,15 ml/min per 1.73 m 2 or on dialysis, respectively. Compared with patients with eGFR$60 ml/min per 1.73 m 2 , the adjusted hazard ratio was significantly lower for patients with eGFR=15 to ,30 ml/min per 1.73 m 2 (interaction P value=0.02). Redefining abnormal cTnT concentration as $0.03 ng/ml or a change of $0.02 ng/ml did not alter results. Because the risk associated with postoperative cTnT levels may be different for patients with eGFR,30 ml/min per 1.73 m 2 , additional research is required to determine how to interpret perioperative cTnT values for patients with low kidney function.

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Section: Discussionmentioning

confidence: 50%

Kidney Function Alters the Relationship between Postoperative Troponin T Level and Death

Walsh

Wang²,

Ong³

et al. 2015

Journal of the American Society of Nephrology

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“…The incidence of elevated cTnT increases as kidney function deteriorates and it is highest in patients on dialysis (7,16,17). However, the proportion of CKD patients with high cTnT levels varies considerably according to the etiology of the renal disease (15,17).…”

Section: These Analyses Extend Previous Observations On the Associatimentioning

confidence: 99%

Patient Survival After Kidney Transplantation: Relationship to Pretransplant Cardiac Troponin T Levels

Hickson

El-Zoghby

Lorenz

et al. 2009

American Journal of Transplantation

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Assessing cardiovascular (CV) risk pretransplant is imprecise. We sought to determine whether cardiac troponin T (cTnT) relates to patient survival posttransplant. The study includes 603 adults, recipients of kidney transplants. In addition to cTnT dobutamine stress echography and coronary angiography were done in 45% and 19% of the candidates respectively. During 28.4 ± 12.9 months 5.6% of patients died or had a major cardiac event. cTnT levels were elevated (>0.01 ng/ml) in 56.2% of patients. Elevated cTnT related to reduced event-free survival (hazard ratio (HR) = 1.81, CI 1.33-2.45, p < 0.0001) whether those events occurred during the first year or beyond. This relationship was statistically independent of all other variables tested, including older age, reduced left ventricular ejection fraction (EF) and delayed graft function. cTnT levels allowed better definition of risk in patients with other CV risk factors. Thus, event-free survival was excellent in older individuals, patients with diabetes, low EF and those with preexisting heart disease if their cTnT levels were normal. However, elevated cTnT together with another CV risk factor(s) identified patient with very poor survival posttransplant. Pretransplant cTnT levels are strong and independent predictors of posttransplant survival. These results suggest that cTnT is quite helpful in CV risk stratification of kidney transplant recipients.

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“…Past reports 24,25 with traditional detection method had different opinions in the relationship between cTnT and LVH. Recent studies applied high sensitive detection method in CKD patients, indicating that hs-cTnT was associated with LVH and LV dysfunction and was an independent predictor of cardiovascular events, cardiovascular mortality and all-cause mortality.…”

Section: Discussionmentioning

confidence: 99%

Assessed value of high-sensitivity cardiac troponin T for cardiovascular disease among CKD patients

et al. 2016

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Objective To analyze the relationship between serum high-sensitivity cardiac troponin T (hs-cTnT) and cardiovascular disease (CVD) among non-dialysis chronic kidney disease (CKD) patients, and to further explore its value of evaluating and predicting CVD in this population. Methods Five hundred and fifty-seven non-dialysis CKD patients were involved in this cross-sectional study. The relationship between serum hs-cTnT and CVD was analyzed using comparison between groups and regression analysis, and its value on assessing cardiac structure and function was evaluated by ROC curves. Results Median level of hs-cTnT was 13 (7-29) ng/L, with 1.7% undetectable, 46.4% greater than 99th percentile of the general population. Multivariate analysis suggested that compared with the lowest quartile of hs-cTnT, the highest quartile was approximately six times as likely to develop into LVH (OR, 6.515; 95% CI, 3.478-12.206, p < 0.05) and 18 times as likely to progress to left ventricular diastolic dysfunction(OR, 18.741; 95% CI, 2.422-145.017, p < 0.05). And Ln cTnT level had a more modest association with LVEF (OR, À1.117; 95% CI, À5.839 to À0.594; p < 0.05). When evaluated as a screening test, the area under the curve of ROC curves for hs-cTnT was 0.718, 0.788 and 0.736, respectively (p < 0.05). With a specificity of 90% as a diagnostic criterion, the value of hs-cTnT to evaluate LVH, LVEF < 50%, left ventricular diastolic dysfunction increased across CKD stages, from CKD 1 stage to CKD 5 stage. Conclusions In CKD non-dialysis population, hs-cTnT and NT-proBNP were valuable for evaluating LVH, left ventricular systolic dysfunction and left ventricular diastolic dysfunction. ARTICLE HISTORY

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Cardiac Troponins and Renal Function in Nondialysis Patients with Chronic Kidney Disease

Cited by 152 publications

References 44 publications

Kidney Function Alters the Relationship between Postoperative Troponin T Level and Death

Kidney Function Alters the Relationship between Postoperative Troponin T Level and Death

Patient Survival After Kidney Transplantation: Relationship to Pretransplant Cardiac Troponin T Levels

Assessed value of high-sensitivity cardiac troponin T for cardiovascular disease among CKD patients

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