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Cardiac troponin T elevation at dialysis initiation is associated with all-cause and cardiovascular mortality on dialysis in patients without diabetic nephropathy

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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.

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Acknowledgments

We express our sincere appreciation to all the patients, collaborating physicians, and other medical staff for their important contributions to the study. We are especially grateful to Shuji Okazaki, MD, PhD (Nagayama Hospital), Hiromi Nogami, MD, PhD (Nogami Hospital), Keiji Mimura, MD, PhD (Nishide Hospital), Kinya Hamada (Daini-Nagisa Hospital), and Yasushi Saika (Kishiwada Fujii Clinic).

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Authors and Affiliations

  1. Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi Sumiyoshi-ku, Osaka, 558-8558, Japan

    Terumasa Hayashi

  2. Department of Nephrology, Rinku General Medical Center, Izumisano, Japan

    Terumasa Hayashi

  3. Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan

    Tomonori Kimura, Keiko Yasuda, Yoshitsugu Obi, Hiromi Rakugi & Yoshitaka Isaka

  4. Department of Nephrology, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan

    Koichi Sasaki

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  1. Terumasa Hayashi
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  2. Tomonori Kimura
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  3. Keiko Yasuda
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  5. Yoshitsugu Obi
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  7. Yoshitaka Isaka
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Correspondence to Terumasa Hayashi.

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Hayashi, T., Kimura, T., Yasuda, K. et al. Cardiac troponin T elevation at dialysis initiation is associated with all-cause and cardiovascular mortality on dialysis in patients without diabetic nephropathy. Clin Exp Nephrol 21, 333–341 (2017). https://doi.org/10.1007/s10157-016-1278-4

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  • DOI: https://doi.org/10.1007/s10157-016-1278-4

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