Cardiac troponin T predicts long-term outcomes in hemodialysis patients

Background: Increased plasma troponin T (cTnT), but not troponin I (cTnI), is frequently observed in endstage renal failure patients. Although general ly considered spurious, we previously reported an associated increased mort ality at 12 months. Methods: We studied long-term outcomes in 244 patients on chronic hemodialy sis for up to 34 months, correlating the outcomes to plasma cTnT in routine predialysis samples. In addition, subsequent plasma samples at least 1 yea r later and within 6 months of data analysis were available in 97 patients and were used to identify patients with increasing plasma cTnT. The endpoin ts used were death and new or worsening: coronary, cerebro-, and peripheral vascular disease and neuropathy. Results: Transplantation occurred more frequently in patients with low init ial cTnT: 31%, 13%, and 3% in the groups with cTnT <0.010, 0.010-0.099, and <greater than or equal to>0.100 mug/L, respectively. In the same groups, t otal deaths occurred in 6%, 43%, and 59% and cardiac deaths in 0%, 14%, and 24% of patients. In patients with follow-up samples, the group with increa sing cTnT had a significantly increased death (relative risk, 2.0; P = 0.02 8). The increase was mainly in cardiac and sudden deaths. Conclusions: Higher plasma cTnT predicts long-term all-cause mortality in h emodialysis patients, even at concentrations <0.100 mu-g/L, as does an incr easing cTnT concentration over time. (C) 2001 American Association for Clin ical Chemistry.