title: High-sensitivity troponin as a predictor of cardiac events and mortality in the stable dialysis population.
abstract: 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.
  
  
  METHODS
  A total of 393 nonacute HD and PD patients (70% HD and 30% PD) were followed in a prospective observational study for new MI and death.
  
  
  RESULTS
  Median hs-cTnT was 57 ng/L (interquartile range, 36-101 ng/L) with no observed difference between HD and PD patients (P = 0.11). Incremental increases in mortality (P = 0.024) and MI (P = 0.001) were observed with increasing hs-cTnT quartiles. MI incidence increased significantly across quartiles in both HD and PD patients (P = 0.012 and P = 0.025, respectively), whereas mortality increased only in HD patients (P = 0.015). For every increase of 25 ng/L in hs-cTnT, the unadjusted hazard ratio (HR) was 1.10 for mortality in the whole group (95% CI, 1.04-1.16, P = 0.001) and 1.16 for MI (95% CI, 1.08-1.23, P < 0.001). Adjusted HR for mortality was 1.07 (95% CI, 1.01-1.15, P = 0.04) and 1.14 for MI (95% CI, 1.06-1.22, P < 0.001). Changes in hs-cTnT from baseline concentrations after 1 year were minimal (55 ng/L vs 53 ng/L, P = 0.22) even in patients who had an MI (P = 0.53).
  
  
  CONCLUSIONS
  hs-cTnT appears to have a useful role in predicting MI and death in the dialysis population. Over a 1-year period concentrations remained stable even in patients who sustained a new cardiac event.
authors.affiliation: Renal Unit, Liverpool Hospital, Sydney, Australia;
authors.forename: Hicham Cheikh
authors.initials: HC
authors.lastname: Hassan
authors.forename: Kenneth
authors.initials: K
authors.lastname: Howlin
authors.forename: Andrew
authors.initials: A
authors.lastname: Jefferys
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Spicer
authors.forename: Ananthakrishnapuram N
authors.initials: AN
authors.lastname: Aravindan
authors.forename: Govindarajan
authors.initials: G
authors.lastname: Suryanarayanan
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Hall
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Cleland
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Wong
authors.forename: Michael G
authors.initials: MG
authors.lastname: Suranyi
authors.forename: Angela
authors.initials: A
authors.lastname: Makris
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality*; D010530:Peritoneal Dialysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T