Troponin I levels in asymptomatic patients on haemodialysis using a high-sensitivity assay

Kumar, Neeraj; Michelis, Michael F.; Devita, Maria; Panagopoulos, Georgia; Rosenstock, Jordan L.

doi:10.1093/ndt/gfq442

Cited by 47 publications

(69 citation statements)

References 12 publications

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“…Hs-cTnT levels are strongly associated with left ventricular hypertrophy in a large dialysis cohort [16], and a predictor of death in several recent reports [17,18,19]. However, the utility of a combination of hs-cTnT with natriuretic peptides for recognizing patients at high risk for major CV events or death has still not been explore.…”

Section: Introductionmentioning

confidence: 99%

Superior Predictive Value for NTproBNP Compared with High Sensitivity cTnT in Dialysis Patients: A Pilot Prospective Observational Study

Voroneanu

Siriopol

Nistor

et al. 2014

Kidney Blood Press Res

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Background/Aims: The clinical utility of the new biomarker, high sensitivity cardiac T troponin (hs-cTnT) is still unclear in dialysis patients. Furthermore, the prognostic value of combining N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and hs-cTnT has not been explored so far. The objective of this pilot study was to determine the utility of hs-cTnT alone versus hs-cTnT in combination with NT-proBNP for predicting death in a stable hemodialysis cohort. Methods: A prospective observational pilot study including 98 chronic asymptomatic hemodialysis patients with a follow up period of 24 months was designed. The cut-off values for NT-proBNP and hs-cTnT were calculated using receiver operating characteristic (ROC) analysis, using mortality as an end-point. Based on the cut-off values, the cohort was divided into four groups. Group 1 - NT-proBNP < 14275 pg/ml and hs-cTnT < 69.48 ng/l; group 2 - NT-proBNP < 14275 pg/ml and hs-cTnT > 69.48 ng/l; group 3 - NT-proBNP > 14275 pg/ml and hs-cTnT < 69.48 ng/l; group 4 - NT-proBNP > 14275 pg/ml and hs-cTnT > 69.48 ng/l. Survival for each group was determined using the Kaplan-Meier method and Cox regression analysis. Results: During the follow-up period 16 patients died. According to the ROC curves analysis, the cut-off point for hs-cTnT and for NT-proBNP were 69.43 ng/l (AUC = 0.618; p = 0.04) and 14275 pg/ml (AUC = 0.722; p = 0.003), respectively. In univariate Cox analysis, both hs-cTnT (HR = 3.34; p = 0.016) and NT-proBNP (HR = 5.94; p = 0.01) were predictors of death. In the multivariable Cox proportional hazards model, only NT-pro-BNP levels above the cut-off value remained an independent predictor of all-cause mortality. The combined elevation of both biomarkers did not improve significantly the prognostic value compared with NT-proBNP alone (HR = 6.15 versus HR =4 .78; p = 0.338). Conclusion: NT-pro-BNP is a strong predictor of overall mortality in asymptomatic hemodialysis patients. The addition of hs-cTnT did not improve the prognostic accuracy compared with NT proBNP alone.

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Section: Introductionmentioning

confidence: 99%

Superior Predictive Value for NTproBNP Compared with High Sensitivity cTnT in Dialysis Patients: A Pilot Prospective Observational Study

Voroneanu

Siriopol

Nistor

et al. 2014

Kidney Blood Press Res

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“…We found, that by using a more sensitive cTnT assay 94% of our patients had cTnT elevations above the 99 th percentile with the hs-cTnT assay (Jacobs et al, 2009). Others have similarly found a larger amount of cTnI elevations in ESRD patients by using more sensitive cTnI assays (Hickman et al, 2007;Kumar et al, 2010). With respect to the occurrence of cTn elevations in ESRD patients one should also take into account that the cTn concentrations in ESRD patients can vary over time, even in otherwise clinically stable patients.…”

Section: Fig 3 (A)mentioning

confidence: 60%

“…The exact frequency of these elevations varies somewhat between studies, depending on the patient inclusion criteria, the applied cut-off values and the troponin assay used. In general, cTnT has been found elevated more often than cTnI (roughly 53% for cTnT and 17% for cTnI as reviewed in (Kanderian & Francis, 2006)) although recent publications, using more sensitive assays suggest that the frequency of cTnT and cTnI elevations are similar (Hickman et al, 2007;Kumar, Michelis, Devita, Panagopoulos, & Rosenstock, 2010). It is important to note that the number of detected cTn elevations depends on the cut-offs that are used to define elevated values.…”

Section: Cardiac Troponin Elevations In Esrdmentioning

confidence: 99%

Cardiac Biomarkers in End-Stage Renal Disease

Jacobs¹,

Mingels²,

Dieijen-Visser³

2012

Chronic Kidney Disease and Renal Transplantation

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“…Our current study shows that even moderate elevations of cTnI, even below or slightly higher than the 99th percentile in 59.2% of patients in this study. In the study by Kumar et al [ 11 ], 75% of patients had stable cTnI values over time. Our study demonstrates that the mean cTnI of 3-monthly measurements show a similar correlation with mortality compared to a random (first) measurement.…”

Section: Discussionmentioning

confidence: 92%

“…Diverse outcomes in previous studies addressing the association of cTnI with mortality were in part due to problems with the standardization of cTnI assays. One high-sensitivity cTnI assay has recently been studied in hemodialysis patients by Kumar et al [ 11 ], but this study had a smaller group of patients with a shorter follow-up and mortality was not reported. Our current study shows that even moderate elevations of cTnI, even below or slightly higher than the 99th percentile in 59.2% of patients in this study.…”

Section: Discussionmentioning

confidence: 99%

Moderate elevations of high-sensitivity cardiac troponin I and B-type natriuretic peptide in chronic hemodialysis patients are associated with mortality

Geerse

Berkel

Vogels

et al. 2012

Clinical Chemistry and Laboratory Medicine (CCLM)

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Document VersionPublisher's PDF, also known as Version of Record (includes final page, issue and volume numbers) Please check the document version of this publication:• A submitted manuscript is the author's version of the article upon submission and before peer-review. There can be important differences between the submitted version and the official published version of record. People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website.• The final author version and the galley proof are versions of the publication after peer review.• The final published version features the final layout of the paper including the volume, issue and page numbers. Link to publication General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Background: Several biomarkers are associated with mortality in hemodialysis patients. In particular, elevated cardiac troponin T and B-type natriuretic peptide (BNP) are strong predictors of mortality; however, less is known about cardiac troponin I (cTnI). Elevated troponin I is detected in many hemodialysis patients, but the association of moderate elevations with mortality is unclear. Methods: The relation between mortality and cTnI, using a high-sensitivity cTnI assay, as well as BNP and C-reactive protein (CRP) was evaluated in 206 chronic hemodialysis patients. Results: Median follow-up was 28 months with a total mortality of 35%. Mortality was significantly associated with elevated cTnI, BNP and CRP. Even patients with only moderate elevation of cTnI (0.01 -0.10 μ g/L) showed 2.5-fold increased mortality. Interestingly, hazard ratios for mortality for single (random) measurements were comparable to those for mean/median measurements. Subsequently, subgroup analysis based on combined markers was performed. Patients with both cTnI < 0.01 μ g/L and BNP in the first quartile had 100% survival. Patients with either cTnI < 0.01 μ g/L or BNP in the lowest quartile had significantly lower mortality (12% and 13%, respectively) than patients with BNP levels in the second quartile or higher and cTnI of 0.01 -0.05 μ g/L and patients with cTnI ≥ 0.05 μ g/L (mortality 46 and 58%, respectively). Conclusions: A combination of moderate elevation of cTnI and BNP provided additional progn...

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Troponin I levels in asymptomatic patients on haemodialysis using a high-sensitivity assay

Cited by 47 publications

References 12 publications

Superior Predictive Value for NTproBNP Compared with High Sensitivity cTnT in Dialysis Patients: A Pilot Prospective Observational Study

Superior Predictive Value for NTproBNP Compared with High Sensitivity cTnT in Dialysis Patients: A Pilot Prospective Observational Study

Cardiac Biomarkers in End-Stage Renal Disease

Moderate elevations of high-sensitivity cardiac troponin I and B-type natriuretic peptide in chronic hemodialysis patients are associated with mortality

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