Terumasa Hayashi1,2, Tomonori Kimura3, Keiko Yasuda3, Koichi Sasaki4, Yoshitsugu Obi3, Hiromi Rakugi3, Yoshitaka Isaka3. 1. Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi Sumiyoshi-ku, Osaka, 558-8558, Japan. t-hayashi@abelia.ocn.ne.jp. 2. Department of Nephrology, Rinku General Medical Center, Izumisano, Japan. t-hayashi@abelia.ocn.ne.jp. 3. Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan. 4. Department of Nephrology, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan.
Abstract
BACKGROUND: It is not known whether asymptomatic cardiac troponin T (cTnT) elevation is associated with all-cause or cardiovascular mortality in non-diabetic and advanced chronic kidney disease (CKD) patients. METHODS: We measured cTnT in 248 consecutive patients at 1-2 weeks before dialysis initiation between March 2005 and August 2010 and followed them prospectively. A Cox proportional hazard model was used to investigate the relationship between cTnT and all-cause and cardiovascular mortality on dialysis. RESULTS: The median age of the patients was 67 years (male 59.3 %), and the prevalence of diabetic nephropathy (DN) was 38.3 %. Asymptomatic cTnT elevation (>0.01 ng/mL) was observed in 196 (79 %) and 111 (73 %) patients among the overall patients and among patients without DN, respectively. A total of 51 patients died during a median follow-up period of 31.6 months. The cTnT level was associated with all-cause [hazard ratio (HR) 1.453; 95 % confidence interval (CI) 1.093-1.931; P = 0.010] and cardiovascular mortality [HR 1.973; 95 % CI 1.127-3.454; P = 0.017] on dialysis after extensive adjustment in the overall patient population. Patients without DN showed similar associations as those for the overall patient population (all-cause mortality: HR 1.566; 95 % CI 1.048-2.339; P = 0.029 and cardiovascular mortality: HR 2.657; 95 % CI 1.115-6.328; P = 0.027). CONCLUSION: Asymptomatic cTnT elevation might be strongly associated with all-cause and cardiovascular mortality in patients without DN, as well as in the overall advanced CKD patients. We suggest that cardiovascular risk in patients with pre-dialysis CKD should be stratified according to cTnT levels.
BACKGROUND: It is not known whether asymptomatic cardiac troponin T (cTnT) elevation is associated with all-cause or cardiovascular mortality in non-diabetic and advanced chronic kidney disease (CKD) patients. METHODS: We measured cTnT in 248 consecutive patients at 1-2 weeks before dialysis initiation between March 2005 and August 2010 and followed them prospectively. A Cox proportional hazard model was used to investigate the relationship between cTnT and all-cause and cardiovascular mortality on dialysis. RESULTS: The median age of the patients was 67 years (male 59.3 %), and the prevalence of diabetic nephropathy (DN) was 38.3 %. Asymptomatic cTnT elevation (>0.01 ng/mL) was observed in 196 (79 %) and 111 (73 %) patients among the overall patients and among patients without DN, respectively. A total of 51 patients died during a median follow-up period of 31.6 months. The cTnT level was associated with all-cause [hazard ratio (HR) 1.453; 95 % confidence interval (CI) 1.093-1.931; P = 0.010] and cardiovascular mortality [HR 1.973; 95 % CI 1.127-3.454; P = 0.017] on dialysis after extensive adjustment in the overall patient population. Patients without DN showed similar associations as those for the overall patient population (all-cause mortality: HR 1.566; 95 % CI 1.048-2.339; P = 0.029 and cardiovascular mortality: HR 2.657; 95 % CI 1.115-6.328; P = 0.027). CONCLUSION: Asymptomatic cTnT elevation might be strongly associated with all-cause and cardiovascular mortality in patients without DN, as well as in the overall advanced CKDpatients. We suggest that cardiovascular risk in patients with pre-dialysis CKD should be stratified according to cTnT levels.
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