Abstract
Objectives
End-stage renal disease is associated with a high risk of cardiovascular disease. We compared the concentration and prognostic ability of high sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) and cardiac myosin-binding protein C (cMyC) among stable hemodialysis patients.
Methods
Patients were sampled before and after hemodialysis. We measured hs-cTnI, hs-cTnT and cMyC and used Cox regressions to assess the association between quartiles of concentrations and all-cause mortality and a combination of cardiovascular events and all-cause mortality during follow-up.
Results
A total of 307 patients were included, 204 males, mean age 66 years (SD 14). Before dialysis, 299 (99 %) had a hs-cTnT concentration above the 99th percentile, compared to 188 (66 %) for cMyC and 35 (11 %) for hs-cTnI. Hs-cTnT (23 %, p<0.001) and hs-cTnI (15 %, p=0.049) but not cMyC (4 %, p=0.256) decreased during dialysis. Follow-up was a median of 924 days (492–957 days); patients in the 3rd and 4th quartiles of hs-cTnT (3rd:HR 3.0, 95 % CI 1.5–5.8, 4th:5.2, 2.7–9.8) and the 4th quartile of hs-cTnI (HR 3.8, 2.2–6.8) had an increased risk of mortality. Both were associated with an increased risk of the combined endpoint for patients in the 3rd and 4th quartiles. cMyC concentrations were not associated with risk of mortality or cardiovascular event.
Conclusions
Hs-cTnT was above the 99th percentile in almost all patients. This was less frequent for hs-cTnI and cMyC. High cTn levels were associated with a 3-5-fold higher mortality. This association was not present for cMyC. These findings are important for management of hemodialysis patients.
Funding source: Herlev Hospital
Award Identifier / Grant number: NA
Funding source: Candys Foundation
Award Identifier / Grant number: 2019-318
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Research ethics: The study was performed in accordance with the Helsinki Declaration II and was approved by The Danish National Committee on Research Ethics (H-3-2013-098) and the Danish Data Protection Agency, Copenhagen (HIH2013-027).
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Author contributions: The idea for the study was conceived by RBH and KKI. The original collection of data and samples was done by TLN and LLP. Analyses were performed by RBH, BA, JHK, LSC, TEK, NS and JPG. Supervision was provided by MS, CR, JPG, HB, MM and KKI. The draft manuscript was written by RBH and KKI. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: M.S. reports lecture fees from Novartis, Bohringer, Novo and Astra Zeneca. M.M. reports consulting fees from Roche Diagnostics and Psyros Diagnostics. M.M. is named as an inventor on a patent held by King’s College London for the detection of cardiac myosin–binding protein C as a biomarker of myocardial injury.
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Research funding: This study was funded by grants from Herlev and Gentofte Hospital and Candys foundation (2019-318). The funders played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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Data availability: Data are available upon reasonable request to the corresponding author (RBH).
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Supplementary Material
This article contains supplementary material (https://doi.org/10.1515/cclm-2023-0071).
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