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Association Between Renal Function and Troponin T Over Time in Stable Chronic Kidney Disease Patients
Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology Huddinge, Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
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2019 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 8, no 21, article id e013091Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
American Heart Association Inc. , 2019. Vol. 8, no 21, article id e013091
Keywords [en]
cardiorenal syndrome; renal disease; renal function; troponin T
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-162827DOI: 10.1161/JAHA.119.013091ISI: 000496996800028PubMedID: 31662068Scopus ID: 2-s2.0-85074286515OAI: oai:DiVA.org:liu-162827DiVA, id: diva2:1380758
Available from: 2019-12-19 Created: 2019-12-19 Last updated: 2020-01-22Bibliographically approved

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Uhlin, Fredrik
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Division of Drug ResearchFaculty of Medicine and Health SciencesDepartment of Nephrology
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