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 |
|
This article has been cited by other articles:
|
|
|
|
 
A. Y.-M. Wang and K.-N. Lai
Use of Cardiac Biomarkers in End-Stage Renal Disease
J. Am. Soc. Nephrol.,
September 1, 2008;
19(9):
1643 - 1652.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. A. Khan, B. R. Hemmelgarn, M. Tonelli, C. R. Thompson, and A. Levin
Prognostic Value of Troponin T and I Among Asymptomatic Patients With End-Stage Renal Disease: A Meta-Analysis
Circulation,
November 15, 2005;
112(20):
3088 - 3096.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Babuin and A. S. Jaffe
Troponin: the biomarker of choice for the detection of cardiac injury
Can. Med. Assoc. J.,
November 8, 2005;
173(10):
1191 - 1202.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S Troyanov, Q H Ly, E Schampaert, H Ammann, G Lalumiere, F Madore, and S Querin
Diagnostic specificity and prognostic value of cardiac troponins in asymptomatic chronic haemodialysis patients: a three year prospective study
Heart,
September 1, 2005;
91(9):
1227 - 1228.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Duman, S. Tokay, A. Toprak, D. Duman, A. Oktay, and I. C. Ozener
Elevated cardiac troponin T is associated with increased left ventricular mass index and predicts mortality in continuous ambulatory peritoneal dialysis patients
Nephrol. Dial. Transplant.,
May 1, 2005;
20(5):
962 - 967.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Boulier, I. Jaussent, N. Terrier, F. Maurice, J.-P. Rivory, L. Chalabi, A.-M. Boularan, C. Delcourt, A.-M. Dupuy, B. Canaud, et al.
Measurement of circulating troponin Ic enhances the prognostic value of C-reactive protein in haemodialysis patients
Nephrol. Dial. Transplant.,
September 1, 2004;
19(9):
2313 - 2318.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Hocher, R. Ziebig, C. Altermann, R. Krause, G. Asmus, C.-M. Richter, T. Slowinski, P. Sinha, and H.-H. Neumayer
Different Impact of Biomarkers as Mortality Predictors among Diabetic and Nondiabetic Patients Undergoing Hemodialysis
J. Am. Soc. Nephrol.,
September 1, 2003;
14(9):
2329 - 2337.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Beciani, A. Tedesco, A. Violante, S. Cipriani, M. Azzarito, A. Sturniolo, and G. Splendiani
Cardiac troponin I (2nd generation assay) in chronic haemodialysis patients: prevalence and prognostic value
Nephrol. Dial. Transplant.,
May 1, 2003;
18(5):
942 - 946.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. S. Jaffe
Testing the wrong hypothesis: the failure to recognize the limitations of troponin assays
J. Am. Coll. Cardiol.,
October 1, 2001;
38(4):
999 - 1001.
[Full Text]
[PDF]
|
|
|
|
