High-sensitivity troponin T predicts worsening of albuminuria in hypertension; results of a nested case-control study with confirmation in diabetes.

Abstract

OBJECTIVE:

Hypertension is an important cause of end-stage renal disease. Development of microalbuminuria is the first clinical sign of renal dysfunction, progressing to macroalbuminuria and eventually resulting in end-stage renal disease (ESRD). Markers that could predict the development of microalbuminuria or macroalbuminuria beyond traditional risk markers would allow for earlier intervention and better prevention of ESRD. We investigated in a case-control study whether circulating levels of the micronecrosis marker high-sensitivity troponin T (hs-TnT) add to predicting the development of microalbuminuria or macroalbuminuria in hypertensive patients and performed a replication study in type 2 diabetic individuals (T2DM).

METHODS:

Cases and controls were extracted from a large (N = 8592) general population cohort with long-term follow-up and repeated measurement of albuminuria (PREVEND-study). Cases were defined by transition in albuminuria stage, that is, from normoalbuminuria to microalbuminuria or from microalbuminuria to macroalbuminuria (average follow-up 2.8 years). Controls with stable albuminuria were pair-matched for age, sex, and albuminuria-status. Hs-TnT was measured at baseline in 75 case/control pairs with hypertension and 33 case/control pairs with T2DM.

RESULTS:

Prior to transition in albuminuria, hs-TnT was higher in cases than in controls [6.6 (3.1-11.6) vs. 5.3 (2.9-8.6) pg/ml, P = 0.05]. The odds for transition in albuminuria increased significantly per SD increase in hs-TnT [2.2 (1.2-4.3), P = 0.02]. In addition, hs-TnT improved prediction of albuminuria transition, with significant increases in integrated discrimination improvement of 0.048, P = 0.02. Similar results were found in the T2DM case-control cohort.

CONCLUSION:

We identified hs-TnT as an independent marker predicting the transition in albuminuria stage in hypertension beyond conventional risk-markers. These findings were confirmed in patients with T2DM.

• Authors: Merel E Hellemons, Hiddo J Lambers Heerspink, Ron T Gansevoort, Dick de Zeeuw, Stephan J L Bakker
• Journal: Journal of hypertension (J Hypertens) Vol. 31 Issue 4 Pg. 805-12 (Apr 2013) ISSN: 1473-5598 [Electronic] Netherlands
• PMID: 23425705 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Troponin T

Topics

• Albuminuria (complications, pathology)
• Case-Control Studies
• Diabetes Mellitus, Type 2 (complications)
• Female
• Humans
• Hypertension (complications)
• Male
• Troponin T (analysis)