title: Cardiac troponins and renal function in nondialysis patients with chronic kidney disease.
abstract: BACKGROUND
  Serum cardiac troponin concentrations are commonly increased in end-stage renal disease (ESRD) in the absence of an acute coronary syndrome (ACS). The data on cardiac troponin I (cTnI) are more variable than those for cardiac troponin T (cTnT). There is little information on cardiac troponin concentrations in patients with chronic kidney disease (CKD) who have not commenced dialysis.
  
  
  METHODS
  We studied 222 patients: 56 had stage 3 (moderate CKD); 70 stage 4 (severe CKD); and 96 stage 5 (kidney failure). Patients underwent echocardiography and were followed prospectively for a median of 19 months; all-cause mortality was recorded.
  
  
  RESULTS
  Overall, serum cTnT was increased above the 99th percentile reference limit in 43% of all CKD patients studied, compared with 18% for cTnI. Serum cTnT and cTnI concentrations were more commonly increased in the presence of more severe CKD (11 and 6 patients in stage 3, 27 and 8 in stage 4, and 57 and 24 in stage 5 (P < 0.0001 and <0.02, respectively). Among 38 patients with detectable cTnI, 32 had detectable cTnT (r(s) = 0.67; P < 0.0001). There was evidence that decreasing estimated glomerular filtration rate increased the odds of having detectable cTnT (P < 0.001) but not cTnI (P = 0.128). There was no evidence to support an adjusted association of detectable cardiac troponins with increasing left ventricular mass index. Increased cTnT (P = 0.0097), but not cTnI, was associated with decreased survival.
  
  
  CONCLUSIONS
  Increased cTnT and cTnI concentrations are relatively common in predialysis CKD patients, in the absence of an ACS, including among those with stage 3 disease. The presence of left ventricular hypertrophy alone does not explain these data. Detectable cTnT was a marker of decreased survival.
authors.affiliation: Department of Renal Medicine, East Kent Hospitals NHS Trust, Canterbury, UK.
authors.forename: Nasir A
authors.initials: NA
authors.lastname: Abbas
authors.forename: R Ian
authors.initials: RI
authors.lastname: John
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Webb
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Kempson
authors.forename: Aisling N
authors.initials: AN
authors.lastname: Potter
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Price
authors.forename: Susan
authors.initials: S
authors.lastname: Vickery
authors.forename: Edmund J
authors.initials: EJ
authors.lastname: Lamb
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis; D007676:Kidney Failure, Chronic / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate; D019210:Troponin I / Q000097:blood*; D020107:Troponin T / Q000097:blood*; D014511:Uremia / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology*
chemical_list: D019210:Troponin I; D020107:Troponin T