High-sensitivity Troponin T in hemodialysis patients: a randomized placebo-controlled sub-study investigating angiotensin-II-blockade, variation over time and associations with clinical outcome

Abstract

Background Troponin T (TnT) is a well-known risk factor for negative outcome in hemodialysis (HD) patients, but little is known about variation over time, and the impact of clinical and dialysis specific factors. This study investigated the effect of angiotensin II receptor blockade (ARB), short and long-term variation in TnT and associations with clinical parameters. Methods In this analysis based on the SAFIR-cohort (Clinical Trials ID: NCT00791830) 81 HD patients were randomized double-blind for placebo (n = 40) or angiotensin II receptor blocker (ARB) treatment (n = 41) with irbesartan (150–300 mg) and followed for 12 months with six serial measurements of TnT using a high-sensitivity assay. Results Fifty-four patients (67%) completed follow-up. Baseline TnT-medians (min-max) were (placebo/ARB): 45(14–295)/46(10–343) ng/L. ARB-treatment did not significantly affect mean TnT-levels over the 12-month study period. Median week-to-week and one-year TnT-variation (5th–95th-percentile range) using all samples regardless of intervention were: 0(− 14–10) ng/L (week-to-week) and 3(− 40–71) ng/L (12 months). Median TnT-amplitude, capturing the change from the lowest to the highest TnT-value observed during the one-year study period was 38% or 20.5 ng/L. Median ratios with 95% limits of agreement were: 1.00(0.73–1.37); P = 0.92 (1 week/baseline; n = 77) and 1.07(0.52–2.25); P = 0.19 (12 months/baseline; n = 54). Baseline TnT was positively correlated with diabetes, ultrafiltration volume, arterial stiffness, change in intradialytic total peripheral resistance and N-terminal pro b-type natriuretic peptide (NT-proBNP) and negatively correlated with hematocrit, residual renal function and change in intradialytic cardiac output. High baseline TnT was associated with a higher risk of admission and cardiovascular (CV) events during follow-up. Increase in TnT over time (ΔTnT = 12-months-baseline) was significantly associated with increase in left ventricular (LV) mass and NT-proBNP and decrease in LV ejection fraction and late intradialytic stroke volume. ΔTnT was not significantly associated with admissions, CV or intradialytic hypotensive events during follow-up. Admissions were significantly more likely with a high (TnT-amplitude> 20.5 ng/L) than a low TnT-amplitude. Peaks in TnT were less frequent in aspirin-treated patients. Conclusion ARB-treatment had no significant effect on TnT-levels. Week-to-week variation was generally low, yet over 12 months individual patients had considerable TnT fluctuations. Rise in TnT over time was significantly correlated with markers of cardiac deterioration. Trial registration ClinicalTrials.gov Identifier: NCT00791830. Date of registration: November 17, 2008. EudraCT no: 2008–001267-11.

Constant Fluid Removal Associates With Greater Risk of Elevated High‐Sensitivity Troponin I Than Downward Sloping Profile Among Maintenance Dialysis Patients With High Ultrafiltration

“…Increased troponin levels have been noted among patients with even asymptomatic IDH [9,10]. High cardiac troponin levels are also associated with mortality among patients on maintenance hemodialysis [11]. High UF and prevalent heart failure are frequent associations for this heightened risk.…”

Constant Fluid Removal Associates With Greater Risk of Elevated High‐Sensitivity Troponin I Than Downward Sloping Profile Among Maintenance Dialysis Patients With High Ultrafiltration

“…Increased troponin levels have been noted among patients with even asymptomatic IDH [9,10]. High cardiac troponin levels are also associated with mortality among patients on maintenance hemodialysis [11]. High UF and prevalent heart failure are frequent associations for this heightened risk.…”

Prognostic Utility of High-Sensitivity Cardiac Troponin I in Hemodialysis Patients Without Acute Coronary Syndrome: A Retrospective Cohort Study

“…Most evidence on the prognostic value of troponins in dialysis patients stems from studies conducted in the early 2000s using conventional assays. These studies demonstrated a strong association between elevated cTnT and cardiovascular mortality, with follow-up ranging from 12 to 24 months [ 11 - 15 ]. However, with the introduction of high-sensitivity troponin assays, especially high-sensitivity cardiac troponin I (hs-cTnI), only a few studies have been published, and their findings have been inconsistent [ 16 - 19 ].…”

Constant Fluid Removal Associates With Greater Risk of Elevated High‐Sensitivity Troponin I Than Downward Sloping Profile Among Maintenance Dialysis Patients With High Ultrafiltration

“…Increased troponin levels have been noted among patients with even asymptomatic IDH [9,10]. High cardiac troponin levels are also associated with mortality among patients on maintenance hemodialysis [11]. High UF and prevalent heart failure are frequent associations for this heightened risk.…”

Prognostic Utility of High-Sensitivity Cardiac Troponin I in Hemodialysis Patients Without Acute Coronary Syndrome: A Retrospective Cohort Study

“…Most evidence on the prognostic value of troponins in dialysis patients stems from studies conducted in the early 2000s using conventional assays. These studies demonstrated a strong association between elevated cTnT and cardiovascular mortality, with follow-up ranging from 12 to 24 months [ 11 - 15 ]. However, with the introduction of high-sensitivity troponin assays, especially high-sensitivity cardiac troponin I (hs-cTnI), only a few studies have been published, and their findings have been inconsistent [ 16 - 19 ].…”

Constant Fluid Removal Associates With Greater Risk of Elevated High‐Sensitivity Troponin I Than Downward Sloping Profile Among Maintenance Dialysis Patients With High Ultrafiltration

“…Increased troponin levels have been noted among patients with even asymptomatic IDH [9,10]. High cardiac troponin levels are also associated with mortality among patients on maintenance hemodialysis [11]. High UF and prevalent heart failure are frequent associations for this heightened risk.…”

Prognostic Utility of High-Sensitivity Cardiac Troponin I in Hemodialysis Patients Without Acute Coronary Syndrome: A Retrospective Cohort Study

“…Most evidence on the prognostic value of troponins in dialysis patients stems from studies conducted in the early 2000s using conventional assays. These studies demonstrated a strong association between elevated cTnT and cardiovascular mortality, with follow-up ranging from 12 to 24 months [ 11 - 15 ]. However, with the introduction of high-sensitivity troponin assays, especially high-sensitivity cardiac troponin I (hs-cTnI), only a few studies have been published, and their findings have been inconsistent [ 16 - 19 ].…”