Abstract 13731: The Association of High-Sensitivity Cardiac Troponin T and Natriuretic Peptide With Incident End-Stage Renal Disease: the Atherosclerosis Risk in Communities Study
Introduction: Although there are abundant data supporting kidney dysfunction as a predictor of cardiac disease, epidemiological data for cardiac dysfunction predating kidney dysfunction are sparse, particularly in the general population.
Hypothesis: High sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are associated with incident end-stage renal disease (ESRD) in the general population, even among those without cardiovascular disease or reduced kidney function at baseline.
Methods: We studied 10,750 white and black participants in the ARIC Study aged 52-75 years, without kidney failure at baseline. We used Cox proportional hazards models to estimate hazard ratios (HRs) of incident ESRD by five categories of plasma hs-cTnT and NT-proBNP (divided at 37th, 57th, 77th, and 91th percentile based on clinical thresholds of hs-cTnT).
Results: During a median follow-up of 11.2 years, 161 participants developed ESRD. hs-cTnT and NT-proBNP were associated with ESRD independent of potential confounders including kidney function and albuminuria, with a steady risk increase for hs-cTnT and a J-shaped relationship for NT-proBNP in Model 3 (Table). hs-cTnT demonstrated significant association even in categories below the clinical cutpoint (Categories 3 and 4) and was more strongly associated with ESRD compared to NT-proBNP. In the subgroup analysis, the associations were consistent among those without prior cardiovascular disease (HR for category 5 vs. 1, 3.33 [1.38-8.03] for hs-cTnT and 1.72 [0.88-3.40] for NT-proBNP) or reduced kidney function (3.54 [1.57-7.98] and 2.62 [1.31-5.24], respectively).
Conclusions: hs-cTnT and NT-proBNP were independently associated with ESRD risk in the general population, with hs-cTnT demonstrating a stronger relationship. This suggests the involvement of cardiac abnormality, particularly cardiac injury, or its causes in the progression of kidney dysfunction.
- © 2013 by American Heart Association, Inc.