Association Between Renal Function and Troponin T Over Time in Stable Chronic Kidney Disease Patients

Nicholas C. Chesnaye, Karolina Szummer, the EQUAL Study Investigators, Peter Bárány, Olof Heimbürger, Hasan Magin, Tora Almquist, Fredrik Uhlin, Friedo W. Dekker, Christoph Wanner, Kitty J. Jager, Marie Evans*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background: People with reduced glomerular filtration rate (GFR) often have elevated cardiac troponin T (cTnT) levels. It remains unclear how cTnT levels develop over time in those with chronic kidney disease (CKD). The aim of this study was to prospectively study the association between cTnT and GFR over time in older advanced-stage CKD patients not on dialysis. Methods and Results: The EQUAL (European Quality Study) study is an observational prospective cohort study in stage 4 to 5 CKD patients aged ≥65 years not on dialysis (incident estimated GFR, <20 mL/min/1.73 m²). The EQUAL cohort used for the purpose of this study includes 171 patients followed in Sweden between April 2012 and December 2018. We used linear mixed models, adjusted for important groups of confounders, to investigate the effect of both measured GFR and estimated GFR on high-sensitivity cTnT (hs-cTnT) trajectory over 4 years. Almost all patients had at least 1 hs-cTnT measurement elevated above the 99th percentile of the general reference population (≤14 ng/L). On average, hs-cTnT increased by 16%/year (95% CI, 13–19; P<0.0001). Each 15 mL/min/1.73 m2 lower mean estimated GFR was associated with a 23% (95% CI, 14–31; P<0.0001) higher baseline hs-cTnT and 9% (95% CI, 5–13%; P<0.0001) steeper increase in hs-cTnT. The effect of estimated GFR on hs-cTnT trajectory was somewhat lower than a previous myocardial infarction (15%), but higher than presence of diabetes mellitus (4%) and male sex (5%). Conclusions: In CKD patients, hs-cTnT increases over time as renal function decreases. Lower CKD stage (each 15 mL/min/1.73 m2 lower) is independently associated with a steeper hs-cTnT increase over time in the same range as other established cardiovascular risk factors.

Original languageEnglish
Article numbere013091
JournalJournal of the American Heart Association
Issue number21
Publication statusPublished - 5 Nov 2019

Bibliographical note

Funding Information:
Funding was received from the European Renal Association–European Dialysis and Transplant Association (ERA‐EDTA), the Swedish Medical Association, the Stockholm County Council ALF and CIMED, Njurfonden (Sweden), the Italian Society of Nephrology (SIN‐Reni), the Dutch Kidney Foundation (SB 142), the Young Investigators grant in Germany, and the National Institute for Health Research (NIHR) in the United Kingdom.

Publisher Copyright:
© 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.


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