High-sensitivity troponin T and C-reactive protein have different prognostic values in hemo- and peritoneal dialysis populations : a cohort study

Titi Chen, Hicham C. Hassan, Pierre Qian, Monica Vu, Angela Makris

Research output: Contribution to journalArticlepeer-review

Abstract

Background--Dialysis patients have an exceedingly high mortality rate. Biomarkers may be useful tools in risk stratification of this population. We evaluated the prognostic value of high-sensitivity cardiac troponin T (hs-cTnT) and CRP (C-reactive protein) in predicting adverse outcomes in stable hemodialysis and peritoneal dialysis (PD) patients. Variability in hs-cTnT was also examined. Methods and Results--A retrospective cohort study included 574 dialysis patients (hemodialysis 347, PD 227). Outcomes examined included mortality and major adverse cardiovascular events, with median follow-up of 3.5 years. hs-cTnT was an independent predictor of both outcomes in hemodialysis and PD patients. Increased risk only became significant when hs-cTnT reached quintile 3 ( > 49 ng/L). Area under the receiver operating curve analysis showed that the addition of hs-cTnT to clinical parameters significantly improved its prognostic performance for mortality in PD patients (P=0.002). CRP was an independent predictor of both outcomes in PD patients only. Only CRP in the highest quintile ( > 16.8 mg/L) was associated with increased risk. hs-cTnT remained relatively stable for the whole follow-up period for hemodialysis patients, whereas for PD patients, hs-cTnT increased by 23.63% in year 2 and 29.13% in year 3 compared with baseline (P < 0.001). Conclusions--hs-cTnT and CRP are useful tools in predicting mortality and major adverse cardiovascular events in hemodialysis and PD patients. Given that hs-cTnT levels increase over time in PD patients, interval monitoring may be valuable for risk assessment. In contrast, hs-cTnT in hemodialysis patients has little interval change and progress monitoring is not indicated.
Original languageEnglish
Article numbere007876
Number of pages18
JournalJournal of the American Heart Association
Volume7
Issue number5
DOIs
Publication statusPublished - 2018

Open Access - Access Right Statement

© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License(https://creativecommons.org/licenses/by-nc/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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