Abstract 3146: Prognostic Value of Cardiac Troponin T and B-Type Natriuretic Peptide Combination in Outpatients on Chronic Hemodialysis: 9-year Outcome Analysis
Background: Serum cardiac troponin T (TnT) and plasma B-type natriuretic peptide (BNP) concentrations each predict adverse events in outpatients on chronic hemodialysis. Little is known, however, about the utility of these biomarkers in combination. We prospectively evaluated whether simultaneous assessment of TnT and BNP could effectively predict overall mortality within 9 years in outpatients on chronic hemodialysis.
Methods: We measured serum TnT and plasma BNP concentrations in pre-dialysis samples obtained from 395 consecutive outpatients on chronic hemodialysis (median age, 61 years; median period of hemodialysis, 83 months). Medical history of systemic hypertension was present in 58% of the patients, diabetes mellitus in 22%, and hypercholesterolemia in 13%, myocardial infarction in 4%, and heart failure in 9%.
Results: During the 9-year follow-up period, there were 125 (32%) overall deaths including 63 cardiovascular deaths. Patients who died were older (median, 67 vs. 58 years, P < 0.0001), and had higher median concentrations of TnT (0.13 vs. 0.06 ng/ml, P < 0.0001) and BNP (500 vs. 243 pg/ml, P < 0.0001) compared with those who did not die. On a multivariate Cox regression analysis including 10 clinical and biochemical variables, elevation (>median value) in TnT (>0.082 ng/ml) and BNP (>283 pg/ml) was independently associated with 9-year overall mortality (relative risk (RR) = 2.7, P < 0.0001; RR = 1.7, P = 0.01). The combination of TnT >0.082 ng/ml and/or BNP >283 pg/ml was correlated with an incremental increase in overall mortality rate within 9 years (Table⇓).
Conclusions: TnT and BNP each provide unique long-term prognostic information in outpatients on chronic hemodialysis. The combination of TnT and BNP allows risk stratification for overall mortality within 9 years in this population.