Cardiac troponin T predicts long-term outcomes in hemodialysis patients.
BACKGROUND
Increased plasma troponin T (cTnT), but not troponin I (cTnI), is frequently observed in end-stage 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 > or = 0.100 microg/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 microg/L, as does an increasing cTnT concentration over time.
Division of Biochemistry, Ottawa Hospital-Civic Campus, 1053 Carling Ave., Ottawa, ON K1Y 4E9 Canada. dsooi@ottawahospital.on.ca
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Ooi
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Zimmerman
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Graham
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Wells
D000368:Aged; D002423:Cause of Death; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism; D006435:Renal Dialysis; D013995:Time; D020107:Troponin T / Q000097:blood*
D020107:Troponin T