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. 2013 Oct 22:14:229.
doi: 10.1186/1471-2369-14-229.

Predictors of high sensitivity cardiac troponin T in chronic kidney disease patients: a cross-sectional study in the chronic renal insufficiency cohort (CRIC)

Ruth F Dubin  1 , Yongmei Li, Jiang He, Bernard G Jaar, Radhakrishna Kallem, James P Lash, Gail Makos, Sylvia E Rosas, Elsayed Z Soliman, Ray R Townsend, Wei Yang, Alan S Go, Martin Keane, Christopher Defilippi, Rakesh Mishra, Myles Wolf, Michael G Shlipak; CRIC Study Investigators
Affiliations

Predictors of high sensitivity cardiac troponin T in chronic kidney disease patients: a cross-sectional study in the chronic renal insufficiency cohort (CRIC)

Ruth F Dubin et al. BMC Nephrol. .

Abstract

Background: Cardiac troponin T is independently associated with cardiovascular events and mortality in patients with chronic kidney disease (CKD). Serum levels of high sensitivity cardiac troponin T (hs-TnT) reflect subclinical myocardial injury in ambulatory patients. We sought to determine the distribution and predictors of hs-TnT in CKD patients without overt cardiovascular disease (CVD).

Methods: We studied 2464 participants within the multi-ethnic Chronic Renal Insufficiency Cohort (CRIC) who did not have self-reported CVD. We considered renal and non-renal factors as potential determinants of hs-TnT, including demographics, comorbidities, left ventricular (LV) mass, serologic factors, estimated glomerular filtration rate (eGFR) and albumin to creatinine ratio.

Results: Hs-TnT was detectable in 81% of subjects, and the median (IQR) hs-TnT was 9.4 pg/ml (4.3-18.3). Analysis was performed using Tobit regression, adjusting for renal and non-renal factors. After adjustment, lower eGFR was associated with higher expected hs-TnT; participants with eGFR < 30 ml/min/1.73 m(2) had 3-fold higher expected hs-TnT compared to subjects with eGFR > 60. Older age, male gender, black race, LV mass, diabetes and higher blood pressure all had strong, independent associations with higher expected hs-TnT.

Conclusions: Knowledge of the determinants of hs-TnT in this cohort may guide further research on the pathology of heart disease in patients with CKD and help to stratify sub-groups of CKD patients at higher cardiovascular risk.

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Figures

Figure 1
Figure 1
Distribution of high sensitivity troponin t among chronic renal insufficiency cohort participants without self-reported cardiovascular disease. Legend: Hs-TnT was detectable in 81% of subjects; median (IQR) of hs-TnT was 9.4 pg/ml (4.3-18.3). All hs-TnT values greater than 100 pg/ml were truncated in one bar at 100.
Figure 2
Figure 2
Joint associations of categories of estimated glomerular filtration rate and albumin to creatinine ratio with high sensitivity troponin t in adjusted tobit regression analyses. Legend: After multivariate adjustment, lower eGFR and higher albuminuria were associated with higher levels of hs-TnT. Final Tobit model adjusted for: age (per SD), female, race, diabetes, SBP categories, albumin (per SD), LV mass, ejection fraction, eGFRcys, ACR, and phosphate and FGF-23 (per SD). SD: standard deviation. SBP: systolic blood pressure. LV: left ventricular. eGFRcys: cystatin- based estimated glomerular filtration rate. ACR: albumin to creatinine ratio. FGF-23: fibroblast growth factor 23.
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