Can cardiac troponin T level be used to predict survival of patients awaiting renal transplantation?

Cardiac troponin T (cTnT) levels are often elevated in chronic kidney disease and correlate with survival of patients receiving dialysis. This commentary discusses a recent paper by Hickson et al. that investigated whether a single cTnT measurement can predict survival of patients on the waiting list for renal transplantation. Elevated cTnT levels (>0.01 ng/ml) were associated with left ventricular hypertrophy, reduced left ventricular ejection fraction and ischemia or resting ventricular wall motion abnormalities on dobutamine stress echocardiography, and also predicted mortality independently of age, diabetes or history of heart disease. Although the authors recommend intensive cardiac evaluation in patients with high cTnT levels on transplantation waiting lists, predicting who is at highest risk of dying on the waiting list has no practical utility unless an intervention can reliably lower that risk. Until then, the time patients spend on dialysis should be minimized by rapid referral for transplantation, prompt and appropriate waitlisting and widespread encouragement of living donation.