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Troponin T elevation has 20-fold increased ESRD rate

Posted in Clinical & Translational, Clinical Diagnostics, Curation, tagged cardiovascular biomarkers, Cardiovascular disease, ESRD, risk indicator, Troponin T on October 25, 2015| Leave a Comment »

Troponin T elevation has 20-fold increased ESRD rate

Larry H. Bernstein, MD, FCAP, Curator

LPBI

Troponin T Predicts End-Stage Renal Disease, Death

NEPHROLOGY 10.23.2015

Salynn Boyles

http://www.medpagetoday.com/Nephrology/ESRD/54258?xid=nl_mpt_DHE_2015-10-24&eun=g337145d0r

The presence of elevated cardiac troponin T in the blood was found to be an early independent predictor of end-stage renal disease and death in both African Americans and whites with hypertension or a family history of high blood pressure, researchers said.

Cardiac troponin T (cTnT) testing is routinely used to diagnose myocardial infarction or assess heart muscle damage in this setting, and several studies suggest that minimally elevated cTnT levels are associated with greater all-cause death risk in older people and in patients with chronic kidney failure.

The newly published study is the first to suggest a role for cTnT as a predictor of end-stage renal disease in patients with hypertension, nephrologistLaTonya Hickson, MD, and colleagues from the Mayo Clinic in Rochester, Minn., wrote in the journal Mayo Clinic Proceedings.

At 10-year follow-up, the estimated cumulative incidence of end-stage renal disease (ESRD) was 27.4% among study participants with abnormal cTnT levels (0.01 ng/mL or higher), compared to 1.3% among participants with lower cTnT levels.

“As patient populations grow older with increasing multimorbidity, identifying those at the highest risk of death or end-stage renal disease could improve patient management strategies,” the researchers wrote.

In an interview with MedPage Today, Hickson noted that cTnT predicted long-term ESRD and death independently of traditional risk factors for cardiovascular disease or end-stage renal disease

Several other recent studies have shown that a highly sensitive assay for cTnT, not yet clinically available in the U.S., can predict death and cardiovascular disease in community-dwelling older people.

For example, an analysis of 4,221 older people participating in the NHLBI’s Cardiovascular Health Study found that elevated levels of cTnT measured with such an assay were associated with a higher risk for cardiovascular death and heart failureindependent of other biomarkers.

Hickson said the idea for examining cTnT as a potential predictor of ESRD stemmed from earlier research by the Mayo team showing an increased risk for death associated with the highest cTnT levels among patients with kidney failure undergoing transplants.

“We now use this marker at Mayo to assess these patients,” she said.

The study included just over 3,000 participants in the National Heart, Lung, and Blood Institute’s GENOA study, originally designed to identify genetic determinants of hypertension in various racial groups.

Just under half (45%) of the participants were white residents of the Rochester, Minn., area and the rest were African American residents of Jackson, Miss. At baseline, a total of 71.3% were hypertensive and 32.5% had evidence of abnormal kidney function (glomerular filtration rate of less than 60 mL/min per 1.73 m²). About half (51.6%) had high sensitivity C-reactive protein levels greater than 3 mg/L.

Just 2.2% (66 of 3,050) had abnormal cTnT levels of 0.01 ng/mL or higher.

In addition to the 20-fold increase seen in risk for ESRD among those with abnormal cTnT, their estimated cumulative incidence of death at 10 years was 47%, compared to 7.3% among those with normal cTnT.

“Abnormal cTnT levels were strongly associated with ESRD and death,” the researchers wrote. “This effect was attenuated but was still highly significant after adjustment for demographic characteristics, estimated glomerular filtration rate, and traditional risk factors for ESRD,” they wrote, with an adjusted hazard ratio of 2.81 (95% CI 1.3-5.9) for ESRD and 3.46 (95% CI 2.3-5.1) for death.

Potential study limitations cited by the researchers included the lack of baseline measurement of urine protein excretion rates in addition to electrocardiogram and echocardiogram studies, “which may have provided insight into the presence of left ventricular hypertrophy, a condition previously associated with abnormal cTnT levels.”

They also noted that limiting the cohort to people with hypertension or belonging to hypertensive families may impact the study’s generalizability.

The researchers concluded that as patient populations grow older and develop more health issues, identifying those with the greatest risk for ESRD will become more important.

“Unfortunately, abnormal cTnT levels, measured with the standard assay, are relatively uncommon and thus do not improve risk prediction enough to support routine use,” they wrote. “Further study is needed to determine whether there is a particular patient group in which cTnT screening would meaningfully improve discrimination between the low- and high-risk patients for these sequelae.”

Funding for this research was provided by the Mayo Foundation, the National Institues of Health, and a Mary Kathryn and Michael B. Panitch Career Development Award.

Co-author Allan S. Jaffe reported receiving consulting fees from “most of the major diagnostic companies.” The other researchers reported no relevant relationships with industry.