Troponin T as a Predictor of End-Stage Renal Disease and All-Cause Death in African Americans and Whites From Hypertensive Families.
OBJECTIVE
To evaluate cardiac troponin T (cTnT) as a predictor of end-stage renal disease (ESRD) and death in a cohort of African American and white community-dwelling adults with hypertensive families.


METHODS
A total of 3050 participants (whites from Rochester, Minnesota; African Americans from Jackson, Mississippi) of the Genetic Epidemiology Network of Arteriopathy study were followed from baseline examination (June 1, 1996, through August 31, 2000) through January 22, 2010. Cox proportional hazards regression models were used to examine the association of cTnT with ESRD and death after adjusting for traditional risk factors.


RESULTS
Cohort demographic characteristics and measurements included 1395 whites (45.7%), 2174 hypertensive (71.3%), 992 estimated glomerular filtration rate of less than 60 mL/min per 1.73 m(2) (32.5%), 1574 high-sensitivity C-reactive protein level of greater than 3 mg/L (51.6%), and 66 abnormal cTnT level of 0.01 ng/mL or higher (2.2%). The estimated cumulative incidence of ESRD at 10 years was 27.4% among those with abnormal cTnT levels compared with 1.3% for those with normal levels. Similarly, the estimated cumulative incidence of death at 10 years was 47% among those with abnormal cTnT compared with 7.3% among those with normal cTnT. Abnormal cTnT levels were strongly associated with ESRD and death. This effect was attenuated but was still highly significant after adjustment for demographic characteristics, estimated glomerular filtration rate, and traditional risk factors for ESRD (unadjusted hazard ratio [HR], 23.91; 95% CI, 12.9-44.2; adjusted HR, 2.81; 95% CI, 1.3-5.9) and death (unadjusted HR, 8.43; 95% CI, 6.0-11.9; adjusted HR, 3.46; 95% CI, 2.3-5.1).


CONCLUSIONS
Cardiac troponin T makes an independent contribution to the prediction of ESRD and all-cause death in community-dwelling individuals beyond traditional risk markers. Further studies may be needed to determine whether cTnT screening in individuals with hypertension or in a subset of hypertensive individuals would help identify those at risk of ESRD and all-cause death.
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN. Electronic address: hickson.latonya@mayo.edu.
LaTonya J
LJ
Hickson
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Andrew D
AD
Rule
Division of Geriatric Medicine, University of Mississippi Medical Center, Jackson, MS.
Kenneth R
KR
Butler
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Gary L
GL
Schwartz
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
Allan S
AS
Jaffe
Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
Adam C
AC
Bartley
Division of Geriatric Medicine, University of Mississippi Medical Center, Jackson, MS.
Thomas H
TH
Mosley
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Stephen T
ST
Turner
D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D003710:Demography; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000208:ethnology; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D008922:Mississippi / Q000453:epidemiology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D020107:Troponin T / Q000097:blood*; D044465:White People / Q000706:statistics & numerical data
D020107:Troponin T