D S Ooi1, D Zimmerman, J Graham, G A Wells. 1. Division of Biochemistry, Ottawa Hospital-Civic Campus, 1053 Carling Ave., Ottawa, ON K1Y 4E9 Canada. dsooi@ottawahospital.on.ca
Abstract
BACKGROUND: Increased plasma troponin T (cTnT), but not troponin I (cTnI), is frequently observed in end-stage renal failure patients. Although generally considered spurious, we previously reported an associated increased mortality at 12 months. METHODS: We studied long-term outcomes in 244 patients on chronic hemodialysis for up to 34 months, correlating the outcomes to plasma cTnT in routine predialysis samples. In addition, subsequent plasma samples at least 1 year later and within 6 months of data analysis were available in 97 patients and were used to identify patients with increasing plasma cTnT. The endpoints used were death and new or worsening coronary, cerebro-, and peripheral vascular disease and neuropathy. RESULTS: Transplantation occurred more frequently in patients with low initial cTnT: 31%, 13%, and 3% in the groups with cTnT < 0.010, 0.010-0.099, and > or = 0.100 microg/L, respectively. In the same groups, total deaths occurred in 6%, 43%, and 59% and cardiac deaths in 0%, 14%, and 24% of patients. In patients with follow-up samples, the group with increasing cTnT had a significantly increased death (relative risk, 2.0; P = 0.028). The increase was mainly in cardiac and sudden deaths. CONCLUSIONS: Higher plasma cTnT predicts long-term all-cause mortality in hemodialysis patients, even at concentrations < 0.100 microg/L, as does an increasing cTnT concentration over time.
BACKGROUND: Increased plasma troponin T (cTnT), but not troponin I (cTnI), is frequently observed in end-stage renal failurepatients. Although generally considered spurious, we previously reported an associated increased mortality at 12 months. METHODS: We studied long-term outcomes in 244 patients on chronic hemodialysis for up to 34 months, correlating the outcomes to plasma cTnT in routine predialysis samples. In addition, subsequent plasma samples at least 1 year later and within 6 months of data analysis were available in 97 patients and were used to identify patients with increasing plasma cTnT. The endpoints used were death and new or worsening coronary, cerebro-, and peripheral vascular disease and neuropathy. RESULTS: Transplantation occurred more frequently in patients with low initial cTnT: 31%, 13%, and 3% in the groups with cTnT < 0.010, 0.010-0.099, and > or = 0.100 microg/L, respectively. In the same groups, total deaths occurred in 6%, 43%, and 59% and cardiac deaths in 0%, 14%, and 24% of patients. In patients with follow-up samples, the group with increasing cTnT had a significantly increased death (relative risk, 2.0; P = 0.028). The increase was mainly in cardiac and sudden deaths. CONCLUSIONS: Higher plasma cTnT predicts long-term all-cause mortality in hemodialysis patients, even at concentrations < 0.100 microg/L, as does an increasing cTnT concentration over time.
Authors: Anna Clementi; Grazia Maria Virzì; Ching Yan Goh; Dinna N Cruz; Antonio Granata; Girogio Vescovo; Claudio Ronco Journal: Cardiorenal Med Date: 2013-04 Impact factor: 2.041
Authors: R Sharma; D C Gaze; D Pellerin; R L Mehta; H Gregson; C P Streather; P O Collinson; S J D Brecker Journal: Heart Date: 2005-10-10 Impact factor: 5.994
Authors: Kelsey Smith; Christopher deFilippi; Tamara Isakova; Orlando M Gutiérrez; Karen Laliberte; Stephen Seliger; Walter Kelley; Show-Hong Duh; Michael Hise; Robert Christenson; Myles Wolf; James Januzzi Journal: Am J Kidney Dis Date: 2012-08-09 Impact factor: 8.860