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High-sensitivity troponins in dialysis patients: variation and prognostic value

BACKGROUND: Dialysis patients have a high prevalence of cardiovascular mortality but also elevated cardiac troponins (cTns) even without signs of cardiac ischaemia. The study aims to assess variation and prognostic value of high-sensitivity cTnI and cTnT in prevalent dialysis patients. METHODS: In 1...

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Autores principales: Snaedal, Sunna, Bárány, Peter, Lund, Sigrún H, Qureshi, Abdul R, Heimbürger, Olof, Stenvinkel, Peter, Löwbeer, Christian, Szummer, Karolina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8243265/
https://www.ncbi.nlm.nih.gov/pubmed/34221386
http://dx.doi.org/10.1093/ckj/sfaa215
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author Snaedal, Sunna
Bárány, Peter
Lund, Sigrún H
Qureshi, Abdul R
Heimbürger, Olof
Stenvinkel, Peter
Löwbeer, Christian
Szummer, Karolina
author_facet Snaedal, Sunna
Bárány, Peter
Lund, Sigrún H
Qureshi, Abdul R
Heimbürger, Olof
Stenvinkel, Peter
Löwbeer, Christian
Szummer, Karolina
author_sort Snaedal, Sunna
collection PubMed
description BACKGROUND: Dialysis patients have a high prevalence of cardiovascular mortality but also elevated cardiac troponins (cTns) even without signs of cardiac ischaemia. The study aims to assess variation and prognostic value of high-sensitivity cTnI and cTnT in prevalent dialysis patients. METHODS: In 198 prevalent haemodialysis (HD) and 78 peritoneal dialysis (PD) patients, 4-monthly serum troponin I and T measurements were obtained. Reference change values (RCVs) were used for variability assessment and competing-risk regression models for survival analyses; maximal follow-up was 50 months. RESULTS: HD and PD patients had similar troponin levels [median (interquartile range) troponin I: 25 ng/L (14–43) versus 21 ng/L (11–37), troponin T: 70 ng/L (44–129) versus 67 ng/L (43–123)]. Of troponin I and T levels, 42% versus 98% were above the decision level of myocardial infarction. RCVs were +68/−41% (troponin I) and +29/−23% (troponin T). Increased variability of troponins related to higher age, male sex, protein-energy wasting and congestive heart failure, but not ischaemic heart disease or dialysis form. Elevated troponin T, but not troponin I, predicted death after adjusting for confounders. CONCLUSIONS: A large proportion of prevalent dialysis patients without current established or ongoing cardiac events have elevated levels of high-sensitivity cTns. Mortality risk was doubled in patients with persistently high troponin T levels. The large intraindividual variation of cTns suggests that serial measurements and reference change levels may be used to improve diagnostic utility. However, evidence-based recommendations require more data from large studies of dialysis patients with cardiac events.
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spelling pubmed-82432652021-07-01 High-sensitivity troponins in dialysis patients: variation and prognostic value Snaedal, Sunna Bárány, Peter Lund, Sigrún H Qureshi, Abdul R Heimbürger, Olof Stenvinkel, Peter Löwbeer, Christian Szummer, Karolina Clin Kidney J Original Articles BACKGROUND: Dialysis patients have a high prevalence of cardiovascular mortality but also elevated cardiac troponins (cTns) even without signs of cardiac ischaemia. The study aims to assess variation and prognostic value of high-sensitivity cTnI and cTnT in prevalent dialysis patients. METHODS: In 198 prevalent haemodialysis (HD) and 78 peritoneal dialysis (PD) patients, 4-monthly serum troponin I and T measurements were obtained. Reference change values (RCVs) were used for variability assessment and competing-risk regression models for survival analyses; maximal follow-up was 50 months. RESULTS: HD and PD patients had similar troponin levels [median (interquartile range) troponin I: 25 ng/L (14–43) versus 21 ng/L (11–37), troponin T: 70 ng/L (44–129) versus 67 ng/L (43–123)]. Of troponin I and T levels, 42% versus 98% were above the decision level of myocardial infarction. RCVs were +68/−41% (troponin I) and +29/−23% (troponin T). Increased variability of troponins related to higher age, male sex, protein-energy wasting and congestive heart failure, but not ischaemic heart disease or dialysis form. Elevated troponin T, but not troponin I, predicted death after adjusting for confounders. CONCLUSIONS: A large proportion of prevalent dialysis patients without current established or ongoing cardiac events have elevated levels of high-sensitivity cTns. Mortality risk was doubled in patients with persistently high troponin T levels. The large intraindividual variation of cTns suggests that serial measurements and reference change levels may be used to improve diagnostic utility. However, evidence-based recommendations require more data from large studies of dialysis patients with cardiac events. Oxford University Press 2020-12-12 /pmc/articles/PMC8243265/ /pubmed/34221386 http://dx.doi.org/10.1093/ckj/sfaa215 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Articles
Snaedal, Sunna
Bárány, Peter
Lund, Sigrún H
Qureshi, Abdul R
Heimbürger, Olof
Stenvinkel, Peter
Löwbeer, Christian
Szummer, Karolina
High-sensitivity troponins in dialysis patients: variation and prognostic value
title High-sensitivity troponins in dialysis patients: variation and prognostic value
title_full High-sensitivity troponins in dialysis patients: variation and prognostic value
title_fullStr High-sensitivity troponins in dialysis patients: variation and prognostic value
title_full_unstemmed High-sensitivity troponins in dialysis patients: variation and prognostic value
title_short High-sensitivity troponins in dialysis patients: variation and prognostic value
title_sort high-sensitivity troponins in dialysis patients: variation and prognostic value
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8243265/
https://www.ncbi.nlm.nih.gov/pubmed/34221386
http://dx.doi.org/10.1093/ckj/sfaa215
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