(Circulation. 2000;102:1964.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Cardiac Troponin T Predicts Mortality in Patients With End-Stage Renal Disease
From the Institute of Clinical Chemistry (J.D., S.W., A.A., C.L.) and the Division of Nephrology (U.D., H.-P.B., K.H.N.), University Hospital Magdeburg, Germany.
Correspondence to Dr Jutta Dierkes, Institute of Clinical Chemistry, Leipziger Str 44, D-39120 Magdeburg, Germany. E-mail jutta.dierkes{at}medizin.uni-magdeburg.de
Background—Patients with end-stage renal disease have a high risk of premature death, mainly as the result of cardiovascular disease (CVD), which is not sufficiently explained by the conventional risk factors. We therefore prospectively investigated total mortality and cardiovascular events in 102 patients on hemodialysis and assessed the prognostic value of baseline disease status and laboratory variables including total homocysteine and cardiac troponin T.
Methods and Results—Patients were followed for 2 years or until their first event of CVD (for outcome variable cardiovascular events, n=33) or death (for outcome variable total mortality, n=28). Survival was computed by the Kaplan-Meier method. Cox proportional hazards model was used to determine independent predictors of CVD events or total mortality. Cardiac troponin T emerged as the most powerful predictor of mortality, resulting in an almost 7-fold risk increase at concentrations >0.10 ng/mL (hazard ratio 6.85, 95% CI 3.04 to 15.45). Total homocysteine level greater than median was also associated with mortality (hazard ratio 2.44, 95% CI 1.10 to 5.40). These hazard ratios did not change substantially after adjustment for other risk factors. Significant predictors for CVD events were baseline diabetes, cerebrovascular disease, serum glucose, and triglycerides. After adjustment, only glucose and triglycerides remained significantly related to CVD events (hazard ratio with 95% CI 1.33 [1.12 to 1.57] and 1.14 [1.04 to 1.26], respectively, for a 1-mmol/L increase in concentration).
Conclusions—We conclude that total homocysteine and particularly cardiac troponin T are important predictors of mortality in patients with end-stage renal disease, whereas other laboratory variables and baseline disease status have less prognostic value.
Key Words: mortality • morbidity • cardiovascular diseases
This article has been cited by other articles:
 |
|
 |
|
  D Blendea, M Blendea, J Banker, and C A McPherson Troponin T elevation after implanted defibrillator discharge predicts survival Heart, July 15, 2009; 95(14): 1153 - 1158. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Y.-M. Wang, C. W.-K. Lam, M. Wang, I. H.-S. Chan, S.-F. Lui, Y. Zhang, and J. E. Sanderson Diagnostic potential of serum biomarkers for left ventricular abnormalities in chronic peritoneal dialysis patients Nephrol. Dial. Transplant., June 1, 2009; 24(6): 1962 - 1969. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. W. Kang, H. J. Na, S. M. Hong, S. K. Shin, S.-W. Kang, K. H. Choi, H. Y. Lee, D.-S. Han, and S. H. Han Prognostic value of elevated cardiac troponin I in ESRD patients with sepsis Nephrol. Dial. Transplant., May 1, 2009; 24(5): 1568 - 1573. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. W. Hamm, H. Möllmann, J.-P. Bassand, and F. van de Werf CHAPTER 16 Acute Coronary Syndromes ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Hayashi, Y. Obi, T. Kimura, K.-i. Iio, S. Sumitsuji, Y. Takeda, Y. Nagai, and E. Imai Cardiac troponin T predicts occult coronary artery stenosis in patients with chronic kidney disease at the start of renal replacement therapy Nephrol. Dial. Transplant., September 1, 2008; 23(9): 2936 - 2942. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Y.-M. Wang and K.-N. Lai Use of Cardiac Biomarkers in End-Stage Renal Disease J. Am. Soc. Nephrol., September 1, 2008; 19(9): 1643 - 1652. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 R. Shah, J. Selter, Y. Wang, M. Greenspan, and J. M. Foody Association of Troponin Status With Guideline-Based Management of Acute Myocardial Infarction in Older Persons Arch Intern Med, August 13, 2007; 167(15): 1621 - 1628. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
S. Korff, H. A Katus, and E. Giannitsis Differential diagnosis of elevated troponins. Heart, July 1, 2006; 92(7): 987 - 993. [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 T. W. Wallace, S. M. Abdullah, M. H. Drazner, S. R. Das, A. Khera, D. K. McGuire, F. Wians, M. S. Sabatine, D. A. Morrow, and J. A. de Lemos Prevalence and Determinants of Troponin T Elevation in the General Population Circulation, April 25, 2006; 113(16): 1958 - 1965. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Bozbas, A. Yildirir, and H. Muderrisoglu Cardiac enzymes, renal failure and renal transplantation. Clin. Med. Res., March 1, 2006; 4(1): 79 - 84. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Satran, C. R. Henry, and T. D. Henry Reply J. Am. Coll. Cardiol., February 7, 2006; 47(3): 691 - 691. [Full Text] [PDF]
|
|
|
|
 |
|
 C. R. Henry, D. Satran, B. Lindgren, C. Adkinson, C. I. Nicholson, and T. D. Henry Myocardial Injury and Long-term Mortality Following Moderate to Severe Carbon Monoxide Poisoning JAMA, January 25, 2006; 295(4): 398 - 402. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
M. E. Suliman, P. Barany, K. Kalantar-Zadeh, B. Lindholm, and P. Stenvinkel Homocysteine in uraemia--a puzzling and conflicting story Nephrol. Dial. Transplant., January 1, 2005; 20(1): 16 - 21. [Full Text] [PDF]
|
|
|
|
|
|
E. R. Perna, S. M. Macin, J. P. C. Canella, N. Augier, J. L. R. Stival, J. R. Cialzeta, A. E. Pitzus, E. H. Garcia, R. Obregon, M. Brizuela, et al. Ongoing Myocardial Injury in Stable Severe Heart Failure: Value of Cardiac Troponin T Monitoring for High-Risk Patient Identification Circulation, October 19, 2004; 110(16): 2376 - 2382. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Boulier, I. Jaussent, N. Terrier, F. Maurice, J.-P. Rivory, L. Chalabi, A.-M. Boularan, C. Delcourt, A.-M. Dupuy, B. Canaud, et al. Measurement of circulating troponin Ic enhances the prognostic value of C-reactive protein in haemodialysis patients Nephrol. Dial. Transplant., September 1, 2004; 19(9): 2313 - 2318. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Giannitsis, H. A. Katus, J. H.C. Diris, C. M. Hackeng, M. P. van Dieijen-Visser, J. P. Kooman, Y. M. Pinto, and W. T. Hermens Troponin T Release in Hemodialysis Patients * Response Circulation, July 20, 2004; 110(3): e25 - e26. [Full Text] [PDF]
|
|
|
|
|
|
B. Hocher, R. Ziebig, R. Krause, G. Asmus, H.-H Neumayer, L. Liefeldt, and J.-P. Stasch Relaxin Is an Independent Risk Factor Predicting Death in Male Patients With End-Stage Kidney Disease Circulation, May 18, 2004; 109(19): 2266 - 2268. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Scholze, C. Rinder, J. Beige, R. Riezler, W. Zidek, and M. Tepel Acetylcysteine Reduces Plasma Homocysteine Concentration and Improves Pulse Pressure and Endothelial Function in Patients With End-Stage Renal Failure Circulation, January 27, 2004; 109(3): 369 - 374. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
B. Hocher, R. Ziebig, C. Altermann, R. Krause, G. Asmus, C.-M. Richter, T. Slowinski, P. Sinha, and H.-H. Neumayer Different Impact of Biomarkers as Mortality Predictors among Diabetic and Nondiabetic Patients Undergoing Hemodialysis J. Am. Soc. Nephrol., September 1, 2003; 14(9): 2329 - 2337. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. deFilippi, S. Wasserman, S. Rosanio, E. Tiblier, H. Sperger, M. Tocchi, R. Christenson, B. Uretsky, M. Smiley, J. Gold, et al. Cardiac Troponin T and C-Reactive Protein for Predicting Prognosis, Coronary Atherosclerosis, and Cardiomyopathy in Patients Undergoing Long-term Hemodialysis JAMA, July 16, 2003; 290(3): 353 - 359. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
P. Ammann, M. Maggiorini, O. Bertel, E. Haenseler, H. I. Joller-Jemelka, E. Oechslin, E. I. Minder, H. Rickli, and T. Fehr Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes J. Am. Coll. Cardiol., June 4, 2003; 41(11): 2004 - 2009. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
C. W. Hamm, E. Giannitsis, and H. A. Katus Cardiac Troponin Elevations in Patients Without Acute Coronary Syndrome Circulation, December 3, 2002; 106(23): 2871 - 2872. [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
S. Fredericks, J. F. Murray, N. D. Carter, A. M.S. Chesser, S. Papachristou, M. M. Yaqoob, P. O. Collinson, D. Gaze, and D. W. Holt Cardiac Troponin T and Creatine Kinase MB Content in Skeletal Muscle of the Uremic Rat Clin. Chem., June 1, 2002; 48(6): 859 - 868. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Herzog Dismal long-term survival of dialysis patients after acute myocardial infarction: can we alter the outcome? Nephrol. Dial. Transplant., January 1, 2002; 17(1): 7 - 10. [Full Text] [PDF]
|
|
|
|
|
|
M. J. Quinn and D. J. Moliterno Troponins in Acute Coronary Syndromes: More TACTICS for an Early Invasive Strategy JAMA, November 21, 2001; 286(19): 2461 - 2462. [Full Text] [PDF]
|
|
|
|
|
|
S. Fredericks, J. F. Murray, M. Bewick, R. Chang, P. O. Collinson, N. D. Carter, and D. W. Holt Cardiac Troponin T and Creatine Kinase MB Are Not Increased in Exterior Oblique Muscle of Patients with Renal Failure Clin. Chem., June 1, 2001; 47(6): 1023 - 1030. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. K. Davis, R. Labugger, J. E. Van Eyk, and F. S. Apple Cardiac Troponin T Is Not Detected in Western Blots of Diseased Renal Tissue Clin. Chem., April 1, 2001; 47(4): 782 - 783. [Full Text] [PDF]
|
|
|
|
|
|
D. S. Ooi, D. Zimmerman, J. Graham, and G. A. Wells Cardiac Troponin T Predicts Long-Term Outcomes in Hemodialysis Patients Clin. Chem., March 1, 2001; 47(3): 412 - 417. [Abstract] [Full Text] [PDF]
|
|