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Moderate elevations of high-sensitivity cardiac troponin I and B-type natriuretic peptide in chronic hemodialysis patients are associated with mortality

  • Daniël A. Geerse EMAIL logo , Miranda van Berkel , Steffie Vogels , Jeroen P. Kooman , Constantijn J.A.M. Konings and Volkher Scharnhorst
Published/Copyright: December 10, 2012

Abstract

Background: Several biomarkers are associated with mortality in hemodialysis patients. In particular, elevated cardiac troponin T and B-type natriuretic peptide (BNP) are strong predictors of mortality; however, less is known about cardiac troponin I (cTnI). Elevated troponin I is detected in many hemodialysis patients, but the association of moderate elevations with mortality is unclear.

Methods: The relation between mortality and cTnI, using a high-sensitivity cTnI assay, as well as BNP and C-reactive protein (CRP) was evaluated in 206 chronic hemodialysis patients.

Results: Median follow-up was 28 months with a total mortality of 35%. Mortality was significantly associated with elevated cTnI, BNP and CRP. Even patients with only moderate elevation of cTnI (0.01–0.10 μg/L) showed 2.5-fold increased mortality. Interestingly, hazard ratios for mortality for single (random) measurements were comparable to those for mean/median measurements. Subsequently, subgroup analysis based on combined markers was performed. Patients with both cTnI <0.01 μg/L and BNP in the first quartile had 100% survival. Patients with either cTnI <0.01 μg/L or BNP in the lowest quartile had significantly lower mortality (12% and 13%, respectively) than patients with BNP levels in the second quartile or higher and cTnI of 0.01–0.05 μg/L and patients with cTnI ≥0.05 μg/L (mortality 46 and 58%, respectively).

Conclusions: A combination of moderate elevation of cTnI and BNP provided additional prognostic value. A single measurement of these biomarkers performed comparably to the mean/median of multiple measurements.


Corresponding author: Daniël A. Geerse, Department of Nephrology, Maastricht University Medical Centre, Postbus 5800, 6202 AZ, Maastricht, The Netherlands

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Received: 2012-05-14
Accepted: 2012-11-09
Published Online: 2012-12-10
Published in Print: 2013-06-01

©2013 by Walter de Gruyter Berlin Boston

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