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CLINICAL STUDY

Prognostic value of serum cardiac troponin I in ambulatory patients with chronic renal failure undergoing long-term hemodialysis

A two-year outcome analysis

Ijaz A. Khan, MD, FACC^*, Norrapol Wattanasuwan, MD, Nirav J. Mehta, MD^*, Aung Tun, MD, FACC, Narpinder Singh, MD, Harinder K. Singh, MD, Balendu C. Vasavada, MD, FACC and Terrence J. Sacchi, MD, FACC

^* Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
Long Island College Hospital, Brooklyn, New York, USA

Manuscript received January 30, 2001; revised manuscript received May 21, 2001, accepted June 28, 2001.

Reprint requests and correspondence: Dr. Ijaz A. Khan, Cardiac Center, Creighton University, 3006 Webster Street, Omaha, Nebraska 68131
ikhan{at}cardiac.ctrighton.edu

OBJECTIVES

We sought to evaluate the prognostic value of cardiac troponin I (cTnI) in asymptomatic, ambulatory patients with chronic renal failure treated with long-term hemodialysis.

BACKGROUND

Smaller, short-term follow-up studies on this subject have given conflicting results.

METHODS

A total of 126 ambulatory patients with chronic renal failure treated with long-term hemodialysis were followed for two years for all-cause mortality, cardiac mortality, all-cause hospital admissions and cardiac hospital admissions. Serum cTnI was measured before dialysis at the time of study entry.

RESULTS

One hundred two patients had normal serum levels of cTnI (0.03 ng/ml) and 24 patients had elevated levels (0.015 ± 0.007 vs. 0.053 ± 0.029 ng/ml, p < 0.0001). No significant difference in all-cause mortality (20 vs. 4 deaths), cardiac mortality (4 vs. 1 death), all-cause hospital admissions (1.74 ± 1.72 vs. 1.25 ± 1.19 admissions/patient) or cardiac admissions (0.52 ± 0.89 vs. 0.33 ± 0.76 admissions/patient) was present between the patients with normal cTnI levels and those with elevated cTnI levels. Serum cTnI was not significantly different between patients who died versus those who survived (0.022 ± 0.019 vs. 0.022 ± 0.021 ng/ml). Serum cTnI was not an independent predictor of all-cause mortality, cardiac mortality, all-cause admissions or cardiac admissions. Age (older) and serum albumin (lower) were independent predictors of all-cause mortality, whereas a history of myocardial infarction was an independent predictor of cardiac mortality. Serum sodium (lower) was an independent predictor of all-cause hospital admissions, whereas hypertension and previous myocardial infarction were independent predictors of cardiac admissions. The best predictors of the time to death were age (older) and serum sodium level (lower), irrespective of the serum cTnI levels.

CONCLUSIONS

Cardiac troponin I has a limited role in predicting mortality and hospital admissions in asymptomatic patients with chronic renal failure treated with long-term hemodialysis.

Abbreviations and Acronyms   CK-MB = creatine kinase-MB isoenzyme   cTnI = cardiac troponin I   cTnT = cardiac troponin T   ECG = electrocardiogram or electrocardiographic   ROC = receiver-operating characteristic

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