title: Moderate elevations of high-sensitivity cardiac troponin I and B-type natriuretic peptide in chronic hemodialysis patients are associated with mortality.
abstract: 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 μg/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 μg/L and BNP in the first quartile had 100% survival. Patients with either cTnI <0.01 μg/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 μg/L and patients with cTnI ≥0.05 μg/L (mortality 46 and 58%, respectively).
  
  
  CONCLUSIONS
  A combination of moderate elevation of cTnI and BNP provided additional prognostic value. A single measurement of these biomarkers performed comparably to the mean/median of multiple measurements.
authors.affiliation: Department of Nephrology, Maastricht University Medical Centre, Maastricht, The Netherlands. dgeerse@hotmail.com
authors.forename: Daniël A
authors.initials: DA
authors.lastname: Geerse
authors.forename: Miranda
authors.initials: M
authors.lastname: van Berkel
authors.forename: Steffie
authors.initials: S
authors.lastname: Vogels
authors.forename: Jeroen P
authors.initials: JP
authors.lastname: Kooman
authors.forename: Constantijn J A M
authors.initials: CJ
authors.lastname: Konings
authors.forename: Volkher
authors.initials: V
authors.lastname: Scharnhorst
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis / Q000378:metabolism*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000032:analysis / Q000378:metabolism*; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D019210:Troponin I / Q000032:analysis / Q000378:metabolism*
chemical_list: D019210:Troponin I; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein