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Articles |
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Divisions of Biochemistry and
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Nephrology, Ottawa Hospital–Civic Campus, 1053 Carling Ave., Ottawa, ON K1Y 4E9 Canada.
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Departments of Epidemiology and Community Medicine,
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Pathology, and
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Medicine, University of
Ottawa, Ottawa, ON K1H 8M5, Canada.
a Address correspondence to this author at: Division of Biochemistry, Department of Pathology and Laboratory Medicine, Ottawa Hospital–Civic Campus, 1053 Carling Ave., Ottawa, ON K1Y 4E9 Canada. Fax 613-761-5401; e-mail dsooi{at}ottawahospital.on.ca.
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 
0.100 µg/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 µg/L, as does an increasing cTnT concentration over time.
The following articles in journals at HighWire Press have cited this article:
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  G. M. Connolly, R. Cunningham, P. T. McNamee, I. S. Young, and A. P. Maxwell Troponin T is an independent predictor of mortality in renal transplant recipients Nephrol. Dial. Transplant., March 1, 2008; 23(3): 1019 - 1025. [Abstract] [Full Text] [PDF]
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 A. Yee-Moon Wang, C. Wai-Kei Lam, M. Wang, I. Hiu-Shuen Chan, W. B. Goggins, C.-M. Yu, S.-F. Lui, and J. E Sanderson Prognostic Value of Cardiac Troponin T Is Independent of Inflammation, Residual Renal Function, and Cardiac Hypertrophy and Dysfunction in Peritoneal Dialysis Patients Clin. Chem., May 1, 2007; 53(5): 882 - 889. [Abstract] [Full Text] [PDF]
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 R Sharma, D C Gaze, D Pellerin, R L Mehta, H Gregson, C P Streather, P O Collinson, and S J D Brecker Cardiac structural and functional abnormalities in end stage renal disease patients with elevated cardiac troponin T Heart, June 1, 2006; 92(6): 804 - 809. [Abstract] [Full Text] [PDF]
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B. Conway, M. McLaughlin, P. Sharpe, and J. Harty Use of cardiac troponin T in diagnosis and prognosis of cardiac events in patients on chronic haemodialysis Nephrol. Dial. Transplant., December 1, 2005; 20(12): 2759 - 2764. [Abstract] [Full Text] [PDF]
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 N. A. Khan, B. R. Hemmelgarn, M. Tonelli, C. R. Thompson, and A. Levin Prognostic Value of Troponin T and I Among Asymptomatic Patients With End-Stage Renal Disease: A Meta-Analysis Circulation, November 15, 2005; 112(20): 3088 - 3096. [Abstract] [Full Text] [PDF]
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N. A. Abbas, R. I. John, M. C. Webb, M. E. Kempson, A. N. Potter, C. P. Price, S. Vickery, and E. J. Lamb Cardiac Troponins and Renal Function in Nondialysis Patients with Chronic Kidney Disease Clin. Chem., November 1, 2005; 51(11): 2059 - 2066. [Abstract] [Full Text] [PDF]
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 H.H.H. Feringa, J.J. Bax, O. Schouten, and D. Poldermans Ischemic heart disease in renal transplant candidates: Towards non-invasive approaches for preoperative risk stratification Eur J Echocardiogr, October 1, 2005; 6(5): 313 - 316. [Abstract] [Full Text] [PDF]
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R. Sharma, D. Pellerin, D.C. Gaze, J.S. Shah, C.P. Streather, P.O. Collinson, and S.J. Brecker Dobutamine stress echocardiography and cardiac troponin T for the detection of significant coronary artery disease and predicting outcome in renal transplant candidates Eur J Echocardiogr, October 1, 2005; 6(5): 327 - 335. [Abstract] [Full Text] [PDF]
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J. Ishii, W. Cui, F. Kitagawa, T. Kuno, Y. Nakamura, H. Naruse, Y. Mori, T. Ishikawa, Y. Nagamura, T. Kondo, et al. Prognostic Value of Combination of Cardiac Troponin T and B-Type Natriuretic Peptide after Initiation of Treatment in Patients with Chronic Heart Failure Clin. Chem., December 1, 2003; 49(12): 2020 - 2026. [Abstract] [Full Text] [PDF]
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R. Ziebig, A. Lun, B. Hocher, F. Priem, C. Altermann, G. Asmus, H. Kern, R. Krause, B. Lorenz, R. Mobes, et al. Renal Elimination of Troponin T and Troponin I Clin. Chem., July 1, 2003; 49(7): 1191 - 1193. [Full Text] [PDF]
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M. Beciani, A. Tedesco, A. Violante, S. Cipriani, M. Azzarito, A. Sturniolo, and G. Splendiani Cardiac troponin I (2nd generation assay) in chronic haemodialysis patients: prevalence and prognostic value Nephrol. Dial. Transplant., May 1, 2003; 18(5): 942 - 946. [Abstract] [Full Text] [PDF]
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 B. J. Freda, W. H. W. Tang, F. Van Lente, W. F. Peacock, and G. S. Francis Cardiac troponins in renal insufficiency: Review and clinical implications J. Am. Coll. Cardiol., December 18, 2002; 40(12): 2065 - 2071. [Abstract] [Full Text] [PDF]
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F. S. Apple, M. M. Murakami, L. A. Pearce, and C. A. Herzog Predictive Value of Cardiac Troponin I and T for Subsequent Death in End-Stage Renal Disease Circulation, December 3, 2002; 106(23): 2941 - 2945. [Abstract] [Full Text] [PDF]
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C. Lowbeer, A. Gutierrez, S. A. Gustafsson, R. Norrman, J. Hulting, and A. Seeberger Elevated cardiac troponin T in peritoneal dialysis patients is associated with CRP and predicts all-cause mortality and cardiac death Nephrol. Dial. Transplant., December 1, 2002; 17(12): 2178 - 2183. [Abstract] [Full Text] [PDF]
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