Prognostic value of serum cardiac troponin I in ambulatory patients with chronic renal failure undergoing long-term hemodialysis (original) (raw)
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American Journal of Kidney Diseases, 1997
0 To determine the incidence and prognostic value of increased serum cardiac troponin I and T concentrations over 12 months in chronic hemodialysis patients, we performed a retrospective chart review in 10 patients undergoing chronic renal hemodialysis randomly selected from the Regional Kidney Disease Program without prior knowledge of their cardiac status. Serum markers of myocardial injury (cardiac troponin I [cTnl], cardiac troponin T [cTnT], and creatine kinase MB [CK-MB]) were measured and clinical outcomes were assessed. At the beginning of the study, 12 of 18 (75%) patients had increased serum enzyme-linked immunosorbent assay (ELISA) cTnT concentrations greater than 0.20 @g/L, eight (80%) had increased serum CK-MB greater than 5.0 &L, and three (19%) had an increased cTnl greater than 0.8 pg/L. Over the l-year study period, the cardiac event rate (n = 4 with fatal myocardial infarction) was correlated to the patients who displayed the higher elevations of cTnT, CK-MB, and cTnl. In the remaining 12 patients studied at the end of 1 year, seven (88%) had increased ELISA cTnT levels and five (42%) had increased CK-MB levels; no patients had elevated cTnl levels. Reanalysis of ELISA cTnT values with a newly formulated Enzyrnun cTnT assay showed no significant differences. Our data suggest that whereas substantial increases in cardiac markers tended to have a poor prognostic outcome, there was a high incidence of increased cTnT and CK-MB concentrations without evidence of myocardial injury in chronic hemodialysis patients. The lack of absolute cardiospecificity of cTnT and CK-MB may prove cTnl to be the desired serum marker for the detection of myocardial injury in patients with chronic renal disease. 0 1997 by the National Kidney Foundation, Inc. INDEX WORDS: Renal disease; myocardial injury; cardiac troponin; creatine kinase MB. T HE BIOCHEMICAL diagnosis of acute myocardial infarction (AMI) is often difficult in patients with chronic renal failure because of frequent false-positive elevations of creatine kinase MB ((X-MB).'
Predictive Value of Cardiac Troponin I and T for Subsequent Death in End-Stage Renal Disease
Circulation, 2002
Background-This study determined the prevalence of increased cardiac troponin I (cTnI) and T (cTnT) in end-stage renal disease (ESRD) patients and whether an increased troponin was predictive of death. Methods and Results-Serum was obtained from 733 ESRD patients and measured for cTnI and cTnT. Relative risks were estimated using Cox proportional hazards regressions univariately and adjusted for age, time on dialysis, and coronary artery disease. Kaplan-Meier curves compared time to event data between groups. Greater percentages of patients had an increased cTnT versus cTnI at each cutoff, as follows: 99th percentile, 82% versus 6%; 10% coefficient of variation, 53% versus 1.0%; and receiver operator characteristic, 20% versus 0.4%. Increased versus normal cTnT was predictive of increased mortality using all cutoffs and only above the 99th percentile for cTnI. Two-year cumulative mortality rates increased (PϽ0.001) with changes in cTnT from normal (Ͻ0.01 g/L, 8.4%) to small (Ն0.01 to Ͻ0.04 g/L, 26%), moderate (Ն0.04 to Ͻ0.1 g/L, 39%), and large (Ն0.1 g/L, 47%) increases. Two-year mortalities were 30% for cTnI Ͻ0.1 g/L and 52% if Ն0.1 g/L. Univariate and adjusted relative risks of death associated with elevated (Ͼ99th percentile) cTnT were 5.0 (CI, 2.5 to 10; PϽ0.001) and 3.9 (CI, 1.9 to7.9; PϽ0.001) and cTnI were 2.0 (CI, 1.3 to 3.3; Pϭ0.008) and 2.1 (CI, 1.3 to 3.3; Pϭ0.007). Age, coronary artery disease, and time on dialysis were also independent predictors of mortality.
Scientific Reports
Previous studies using contemporary cardiac troponin (cTn) assays have shown conflicting results in predictability of mortality and major adverse cardiovascular events (MACEs) in hemodialysis patients. We aimed to evaluate the prognostic values of high-sensitivity cTnT (hs-cTnT) and hs-cTnI for long-term mortality and MACEs in asymptomatic chronic hemodialysis patients. 198 asymptomatic patients undergoing regular hemodialysis (age 62.4 ± 14.8 years) were enrolled. Pre-dialysis hs-cTnT and hs-cTnI levels were measured. The study outcomes were long-term all-cause mortality and MACEs. Median values of hs-cTnT and hs-cTnI were 61.1 ng/L (IQR 36.6–102.0) and 18.4 ng/L (IQR 9.5–36.6), respectively. During a median follow-up of 13.5 months, 30 (15.1%) patients developed MACEs, and 20 (10.1%) patients died. The patients in highest quartile of hs-cTnT level (≥ 102 ng/L) had increased risk of long-term mortality (HR 3.34; 95%CI 1.39–8.04, P = 0.005). However, hs-cTnI levels above highest qua...
Cardiac troponin T predicts long-term outcomes in hemodialysis patients
Clinical Chemistry, 2001
Background: Increased plasma troponin T (cTnT), but not troponin I (cTnI), is frequently observed in endstage renal failure patients. Although generally considered spurious, we previously reported an associated increased mortality at 12 months. Methods: We studied long-term outcomes in 244 patients on chronic hemodialysis for up to 34 months, correlating the outcomes to plasma cTnT in routine predialysis samples. In addition, subsequent plasma samples at least 1 year later and within 6 months of data analysis were available in 97 patients and were used to identify patients with increasing plasma cTnT. The endpoints used were death and new or worsening coronary, cerebro-, and peripheral vascular disease and neuropathy. Results: Transplantation occurred more frequently in patients with low initial cTnT: 31%, 13%, and 3% in the groups with cTnT <0.010, 0.010 -0.099, and >0.100 g/L, respectively. In the same groups, total deaths occurred in 6%, 43%, and 59% and cardiac deaths in 0%, 14%, and 24% of patients. In patients with follow-up samples, the group with increasing cTnT had a significantly increased death (relative risk, 2.0; P ؍ 0.028). The increase was mainly in cardiac and sudden deaths. Conclusions: Higher plasma cTnT predicts long-term all-cause mortality in hemodialysis patients, even at concentrations <0.100 g/L, as does an increasing cTnT concentration over time.
Annals of Clinical Biochemistry, 2009
Background: A single detectable cardiac troponin predicts mortality in patients treated with dialysis. There are limited data on changes in troponin concentration over time and the clinical implications of serial troponin measurement. Methods: Serial cardiac troponin T (cTnT) was assayed five times over 12 months in a prospective cohort study of patients with end-stage kidney disease treated with haemodialysis. A concentration of cTnT !0.04 mg/L was considered increased. Mortality and cardiovascular events were analysed by survival analysis, according to the serial troponin results. Results: From 100 patients who provided a baseline sample for cTnT, 81 completed five serial measurements. The analysis of patients who completed serial cTnT measurements demonstrated that 28 patients (35%) had normal cTnT concentrations in all five samples, 20 patients (24%) had between one and four increased cTnT measurements and 33 patients (41%) had increased concentrations of cTnT in all five samples. The 1.7-y patient survival was 100%, 90% and 78% for patients with zero, one to four, or five out of five concentrations of cTnT increased, respectively (P ¼ 0.037), and the corresponding cardiovascular event-free survival was 100%, 91% and 78%, respectively (P ¼ 0.027). Conclusions: Serial measurements of cTnT concentration were frequently increased in patients receiving haemodialysis. The number of abnormal measurements over time predicted mortality and cardiovascular adverse events.
Nephrology Dialysis Transplantation, 2001
Background. Serum concentrations of the cardiac troponins (cTn) T and I, speci®c markers of myocardial injury, are frequently elevated in haemodialysis patients. The clinical relevance of this is unclear. The aim of this study was to investigate factors associated with increased serum levels of cTn in haemodialysis patients. Methods. We included in this cross-sectional study 258 chronic haemodialysis patients (150 men, age 60"15 years) without acute coronary symptoms. Clinical data, echocardiographic hypertrophy, biochemical status, and haemodialysis regimen were evaluated for each patient. Pre-dialysis serum cTnT (Elecsys, Roche), cTnI (Stratus and RXL, Dade±Berhing), and CK-MB (Stratus, Dade±Berhing) concentrations were determined. Logistic regression was the principal method of analysis. Results. Pre-dialysis levels of cTnT )0.1 nguml (ns48, 18.6% of patients) were associated with age (P-0.001), diabetes (P-0.005), history of ischaemic heart disease (P-0.05), and left ventricular hypertrophy (P-0.05). In multivariate analysis, age odds ratio ((OR) 1.04), diabetes (OR 4.9), and indexed left ventricular mass (OR 1.01) were found to be independently associated with cTnT concentration above the threshold. Only six patients had cTnI-Stratus levels )0.6 nguml. cTnI-RXL levels )0.3 nguml (ns13, 5.0%) were associated with age (Ps0.05) and hypercholesterolaemia (P-0.05). Only age (OR 1.06) remained associated in multivariate analysis. Conclusion. Elevated baseline serum levels of cardiac troponins were associated with cardiovascular risk factors, history of ischaemic heart disease and left ventricular hypertrophy in asymptomatic chronic haemodialysis patients.
Serum troponin T measurement in patients with chronic renal impairment predicts survival and …
Nephrology Dialysis Transplantation, 2003
Background. Cardiovascular mortality in end-stage renal failure patients is high and early risk stratification in these patients may aid clinical management improving outcomes. Cardiac troponin T (cTnT) is a component of the cardiac myocyte which is released into the circulation following myocardial necrosis. It has been shown to be of prognostic significance in patients with unstable angina. The role of cTnT in patients with renal disease remains unclear. The aim of this investigation, therefore, was to assess the prognostic significance of cTnT in chronic renal impairment patients, pre-dialysis. Methods. Ninety-six patients with chronic renal impairment were followed prospectively after cTnT determination by a quantitative laboratory method. The clinical outcomes after 2 years were determined. The measured cTnT values were correlated with biochemical parameters and clinical end-points. Results. A cutoff of 0.1 ng/ml was used in assessing the prognostic significance of cTnT. Twenty-five patients had a cTnT >0.1 ng/ml, whilst 71 had a cTnT 0.1 ng/ml. Twenty-one patients died during the follow-up period. Eleven of these had elevated cTnT at entry into the study. Death rate in the patients with cTnT >0.1 ng/ml was 42% compared with 14% in those with levels below the cutoff. Thirty-three patients died or had a vascular event. The rate of death or a vascular event in the elevated group was 64% compared with 24% in those with levels below the cutoff. At the end of the study, 23 patients were treated by continuous ambulatory peritoneal dialysis, 29 by haemodialysis, 22 had functioning renal transplants and one patient was not on renal replacement therapy. Factors that were found to significantly affect cTnT were diabetes, age and urea. cTnT was found to be a significant predictor of survival in these patients. Patients with high cTnT values were more likely to end up on haemodialysis. No relation of renal function to cTnT level was found. Conclusions. These results show that in patients with renal impairment, the measurement of cTnT prior to commencing renal replacement is a significant independent predictor of survival. cTnT did show potential as a prognostic test to stratify patients with a high cardiovascular risk and may enable intensive risk factor modification in this patient group. This may be of further use in selection of patients' suitability for renal transplantation.
Clinical Chemistry, 2014
BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) is a biomarker used in diagnosing myocardial injury. The clinical utility and the variation of this biomarker over time remain unclear in hemodialysis (HD) and peritoneal dialysis (PD) patients. We sought to determine whether hs-cTnT concentrations were predictive of myocardial infarction (MI) and death and to examine hs-cTnT variability over a 1-year period.
Nephrology Dialysis Transplantation, 2003
Background. Cardiovascular mortality in end-stage renal failure patients is high and early risk stratification in these patients may aid clinical management improving outcomes. Cardiac troponin T (cTnT) is a component of the cardiac myocyte which is released into the circulation following myocardial necrosis. It has been shown to be of prognostic significance in patients with unstable angina. The role of cTnT in patients with renal disease remains unclear. The aim of this investigation, therefore, was to assess the prognostic significance of cTnT in chronic renal impairment patients, pre-dialysis. Methods. Ninety-six patients with chronic renal impairment were followed prospectively after cTnT determination by a quantitative laboratory method. The clinical outcomes after 2 years were determined. The measured cTnT values were correlated with biochemical parameters and clinical end-points. Results. A cut-off of 0.1 ng/ml was used in assessing the prognostic significance of cTnT. Twenty-five patients had a cTnT >0.1 ng/ml, whilst 71 had a cTnT 0.1 ng/ml. Twenty-one patients died during the follow-up period. Eleven of these had elevated cTnT at entry into the study. Death rate in the patients with cTnT >0.1 ng/ml was 42% compared with 14% in those with levels below the cut-off. Thirty-three patients died or had a vascular event. The rate of death or a vascular event in the elevated group was 64% compared with 24% in those with levels below the cut-off. At the end of the study, 23 patients were treated by continuous ambulatory peritoneal dialysis, 29 by haemodialysis, 22 had functioning renal transplants and one patient was not on renal replacement therapy. Factors that were found to significantly affect cTnT were diabetes, age and urea. cTnT was found to be a significant predictor of survival in these patients. Patients with high cTnT values were more likely to end up on haemodialysis. No relation of renal function to cTnT level was found. Conclusions. These results show that in patients with renal impairment, the measurement of cTnT prior to commencing renal replacement is a significant independent predictor of survival. cTnT did show potential as a prognostic test to stratify patients with a high cardiovascular risk and may enable intensive risk factor modification in this patient group. This may be of further use in selection of patients' suitability for renal transplantation.
Journal of the American College of Cardiology, 1999
The purpose of this study was to prospectively evaluate the usefulness of the cardiac troponins as predictors of subsequent cardiac events in patients with chronic renal failure undergoing dialysis. BACKGROUND Cardiac troponin T (cTnT) and I (cTnI) are cardiac markers that are specific for cardiac muscle. They are also excellent prognostic indicators for patients presenting with chest pain. Although cardiac disease is the leading cause of death in dialysis patients, standard methods to diagnose acute coronary syndromes in patients with renal failure are often misleading. METHODS A six-month prospective study was done in a university-affiliated Veterans Hospital's dialysis clinic. Forty-nine patients undergoing chronic dialysis with no complaints of chest pain were followed for cardiac events occurring in the six months after cardiac troponin measurements. These included unstable angina, acute myocardial infarction and cardiac death. An additional 83 patients with renal failure but who were not undergoing dialysis were also examined.