Prognostic Value of High-Sensitivity Versus Conventional Cardiac Troponin T Assays Among Patients With Type 2 Diabetes Mellitus Undergoing Maintenance Hemodialysis.

Abstract

BACKGROUND:

Mortality is high among patients undergoing hemodialysis for whom cardiac troponin concentration is a strong predictor of outcome. Modern troponin assays allow measurement of very low concentrations.

STUDY DESIGN:

Using data from a randomized controlled trial, a cohort analysis to evaluate the prognostic value of very low cardiac troponin T (TnT) concentrations.

SETTING & PARTICIPANTS:

1,255 patients with end-stage renal disease and type 2 diabetes mellitus undergoing maintenance hemodialysis from the German Diabetes and Dialysis Study (4D) who had a median follow-up of 4 years.

INDEX TEST, REFERENCE TEST, AND OUTCOME:

Cardiac TnT was measured using a high-sensitivity assay (hs-TnT) and a conventional assay (conventional TnT) in a subpopulation (n=1,034) with valid measurements for both assays. Outcome measures were all-cause mortality and a composite cardiovascular end point including cardiac death, myocardial infarction, or stroke.

RESULTS:

Among the 1,034 study participants, 505 died and 377 had a cardiovascular event. Both hs-TnT and conventional TnT concentrations were associated with mortality and cardiovascular events in models adjusted for cardiovascular risk factors and dialysis-associated variables. 455 (44%) patients with very low TnT concentrations (hs-TNT < 50ng/L) would have been classified as normal by the conventional TnT assay. Among these patients, hs-TnT concentrations were also associated with mortality.

LIMITATIONS:

The study of patients with type 2 diabetes may limit generalizability. These findings have not been externally validated.

CONCLUSIONS:

In patients with type 2 diabetes mellitus receiving hemodialysis, cardiac TnT is associated with long-term mortality and cardiovascular outcomes. Concentrations of TnT not measurable with acceptable precision using a conventional TnT assay were associated with a poor prognosis when measured using a high-sensitivity assay.

• Authors: Till Keller, Christoph Wanner, Vera Krane, Daniel Kraus, Bernd Genser, Hubert Scharnagl, Winfried März, Christiane Drechsler
• Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 71 Issue 6 Pg. 822-830 (06 2018) ISSN: 1523-6838 [Electronic] United States
• PMID: 29310884 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Troponin T

Topics

• Aged
• Biomarkers (blood)
• Cohort Studies
• Comorbidity
• Databases, Factual
• Diabetes Mellitus, Type 2 (diagnosis, epidemiology, therapy)
• Female
• Germany
• Humans
• Kidney Failure, Chronic (diagnosis, epidemiology, therapy)
• Maintenance
• Male
• Middle Aged
• Myocardial Infarction (blood, epidemiology, physiopathology)
• Predictive Value of Tests
• Prognosis
• Renal Dialysis (methods)
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index
• Survival Analysis
• Treatment Outcome
• Troponin T (blood)