Serum troponin T concentration as a predictor of mortality in hemodialysis and peritoneal dialysis patients.
BACKGROUND
Troponin T is a good predictor of all-cause and cardiovascular mortality in cardiac patients. Although it is known that troponin T is an independent risk factor in dialysis patients as well, its prognostic value when measured routinely in clinical practice, particularly in addition to other risk indicators, is unclear.


METHODS
A cohort of 847 patients who started dialysis therapy between 1997 and 2001 and participated in a multicenter follow-up study was examined. Clinical data were determined 3 months after the start of dialysis therapy. Patients were followed up until date of death or censoring in November 2003.


RESULTS
For patients with troponin T values of 0.05 to 0.10 microg/L, hazard ratio for all-cause mortality was 2.2 (95% confidence interval [CI], 1.7 to 2.8) compared with patients with values less than 0.05 microg/L. For patients with values greater than 0.10 microg/L (11%), hazard ratio was 3.3 (95% CI, 2.5 to 4.5). A survival model with clinical and laboratory risk indicators yielded an area under the curve of 0.81, which did not increase when troponin T level was added to the model. The area under the curve for troponin T level alone was 0.67. No important differences were found between patients on hemodialysis or peritoneal dialysis therapy and between patients with high and low residual renal function.


CONCLUSIONS
Although troponin T level is an independent risk factor for mortality in dialysis patients, it has limited added predictive power as a routine screening test over other clinical risk factors in dialysis patients.
Havekes
Bas
B
Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
van Manen
Jeannette G
JG
Krediet
Raymond T
RT
Boeschoten
Elisabeth W
EW
Vandenbroucke
Jan P
JP
Dekker
Friedo W
FW
D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011379:Prognosis; D006435:Renal Dialysis; D020107:Troponin T / Q000097:blood*
D020107:Troponin T