Troponin I is an independent marker of cardiovascular mortality risk in chronic kidney disease patients

Abstract

Introduction:  Cardiovascular disease (CVD) is the main cause of death among chronic kidney disease (CKD) patients. However, the cardiovascular (CV) prognostic evaluation in CKD is not established. Despite previous reports establishing troponin as a CV mortality prognosticator in CKD, there is no consensus on its applicability. Moreover, studies on high-sensitivity troponin I (hsTnI) in this context are scarce. We evaluated the association between hsTnI and CV and overall mortality among CKD patients to identify higher CV-risk patients.

Methods:  145 patients with CKD stages 3 to 5 underwent measurements of hsTnI, inflammatory, calcium-phosphorus metabolism, vascular calcification, and echocardiographic parameters. The association of hsTnI with CV and overall mortality after follow-up was established using Kaplan-Meier curves. The cutoff value of hsTnI for predicting CV and overall mortality was defined using ROC curve analysis. Multivariate analysis for CV and overall mortality was done using Cox regression models.

Results:  HsTnI cutoff value for overall and CV mortality was 0.057 ng/mL. Patients with higher hsTnI had higher CV and overall mortality. In multivariate analysis, hsTnI was a marker of increased CV mortality (hazard ratio 12.8 (95% CI 1.56–105.08), p = 0.018), independent of age, sex, previous CVD, diabetes and dialysis, echocardiographic findings, and osteo­protegerin (OPG).

Conclusion:  HsTnI is independently associated with CV mortality in CKD patients, suggesting that it may be a potential CV risk stratification marker.

Keywords:
Troponin; Renal Insufficiency, Chronic; Cardiovascular Diseases; Cardiac Events