Abstract 15241: Cardiac Troponin T, Natriuretic Peptide, and Long-term Risk of Acute Kidney Injury in the Community: The Atherosclerosis Risk in Communities Study

Abstract

Introduction: Acute kidney injury (AKI) is an important clinical and public health issue, with a high rate of adverse outcomes. A few small studies demonstrate that cardiac troponin T (cTnT) and B-type natriuretic peptide (BNP) before surgery or revascularization predict incident AKI after those procedures. However, whether this association holds in a long term among the general population is unknown.

Hypothesis: High-sensitivity cTnT (hs-cTnT) and N-terminal pro-BNP (NT-proBNP) are associated with incident AKI in the general population, even among those without cardiovascular disease (CVD) or chronic kidney disease (CKD) at baseline.

Methods: We studied 10,733 ARIC participants aged 53-75 years, without kidney failure at baseline. We used Cox proportional hazards models to estimate hazard ratios (HRs) of incident AKI (hospitalizations or deaths with ICD codes of AKI) by five categories of plasma hs-cTnT and NT-proBNP (divided at 32th, 57th, 77th, and 91th percentile based on clinical thresholds of hs-cTnT for fair comparison of two markers).

Results: During a median follow-up of 13 years, there were 796 AKI events. hs-cTnT and NT-proBNP were significantly associated with AKI risk, independently of each other and potential confounders including kidney function and albuminuria (Model 3 in Table). Even categories 2-4 of hs-cTnT and NT-proBNP below their clinical cutpoints reached statistical significance. The associations were consistent among individuals without CVD (HR for category 5 vs. 1, 3.17 [2.28-4.40] for hs-cTnT and 2.60 [1.89-3.56] for NT-proBNP) or those without CKD at baseline (3.25 [2.34-4.52] and 3.52 [2.60-4.77], respectively).

Conclusions: hs-cTnT and NT-proBNP were independently associated with long-term risk of AKI in the community. These cardiac markers attract attention for cardiovascular prediction in the general population and may also provide useful information on the risk of AKI, which can also occur in the outpatient setting.