Association Between Renal Function and Troponin T Over Time in Stable Chronic Kidney Disease Patients
Authors: Chesnaye Nicholas C. , Szummer Karolina , Bárány Peter , Heimbürger Olof , Magin Hasan , Almquist Tora , Uhlin Fredrik , Dekker Friedo W. , Wanner Christoph , Jager Kitty J , Evans Marie , Cupisti Adamasco , Sagliocca Adelia , Ferraro Alberto , Musiała Aleksandra , Mele Alessandra , Naticchia Alessandro , Còsaro Alex , Woodman Alistair , Ranghino Andrea , Stucchi Andrea , Jonsson Andreas , Schneider Andreas , Pignataro Angelo , Schrander Anita , Torp Anke , McKeever Anna , Szymczak Anna , Blom Anna‐Lena , De Blasio Antonella , Pani Antonello , Tsalouichos Aris , Ullah Asad , McLaren Barbara , van Dam Bastiaan , Iwig Beate , Antonio Bellasi , Iorio Biagio Raffaele Di , Rogland Björn , Perras Boris , Alessandra Butti , Harron Camille , Wallquist Carin , Siegert Carl , Barrett Carla , Gaillard Carlo , Abaterusso Cataldo , Beerenhout Charles , O'Toole Charlotte , Somma Chiara , Marx Christian , Drechsler Christiane , Summersgill Christina , Blaser Christof , D'alessandro Claudia , Emde Claudia , Torino Claudia , Zullo Claudia , Pozzi Claudio , Geddes Colin , Verburgh Cornelis , Janmaat Cynthia , Bergamo Daniela , Ciurlino Daniele , Motta Daria , Glowski Deborah , McGlynn Deborah , Vargas Denes , Krieter Detlef , Russo Domenico , Fuchs Dunja , Sands Dympna , Hoogeveen Ellen , Irmler Ellen , Dimény Emöke , Favaro Enrico , Platen Eva , Olczyk Ewelina , Hoorn Ewout , Vigotti Federica , Caskey Fergus , Ansali Ferruccio , Conte Ferruccio , Cianciotta Francesca , Giacchino Francesca , Cappellaio Francesco , Pizzarelli Francesco , Sundelin Fredrik , Greco Gaetano , Roy Geena , Porto Gaetana , Bigatti Giada , Marinangeli Giancarlo , Cabiddu Gianfranca , Hirst Gillian , Fumagalli Giordano , Caloro Giorgia , Piccoli Giorgina , Capasso Giovanbattista , Gambaro Giovanni , Tognarelli Giuliana , Bonforte Giuseppe , Conte Giuseppe , Toscano Giuseppe , Rosso Goffredo Del , Welander Gunilla , Augustyniak‐Bartosik Hanna , Boots Johannes , Schmidt‐Gürtler Hans , King Hayley , McNally Helen , Schlee Hendrik , Boom Henk , Naujoks Holger , Masri‐Senghor Houda , Murtagh Hugh , Rayner Hugh , Miśkowiec‐Wiśniewska Ilona , Schlee Ines , Capizzi Irene , Cäsar Sabine , Hernandez Isabel Bascaran , Baragetti Ivano , Manitius Jacek , Turner Jane , Eijgenraam Jan‐Willem , Kooman Jeroen , Beige Joachim , Pondel Joanna , Wilcox Joanne , Berdeprado Jocelyn , Röthele Jochen , Wong Jonathan , Rotmans Joris , Banda Joyce , Mazur Justyna , Hahn Kai , Jędrzejak Kamila , Nowańska Katarzyna , Blouin Katja , Neumeier Katrin , Jones Kirsteen , Anding‐Rost Kirsten , Gröntoft Knut‐Christian , Oldrizzi Lamberto , Haydock Lesley , Vogt Liffert , Wilkinson Lily , Gesualdo Loreto , Schramm Lothar , Biancone Luigi , Nowak Łukasz , Raasveld Maarten , Szymczak Maciej , Durlik Magdalena , Magnano Manuela , Vervloet Marc , Ricardi Marco , Carmody Margaret , Di Bari Maria , Laudato Maria , Sirico Maria Luisa , Stendahl Maria , Svensson Maria , Weetman Maria , van Buren Marjolijn , Joinson Martin , Ferraresi Martina , Dutton Mary , Postorino Maurizio , van Diepen Merel , Matthews Michael , Provenzano Michele , Hopf Monika , Malaguti Moreno , Wuttke Nadja , Morgan Neal , Palmieri Nicola , Frischmuth Nikolaus , Bleakley Nina , Murrone Paola , Cockwell Paul , Leurs Paul , Roderick Paul , Voskamp Pauline , Kashioulis Pavlos , Ichtiaris Pawlos , Blankestijn Peter , Kirste Petra , Schulz Petra , Mason Phil , Kalra Philip , Cirillo Pietro , Dattolo Pietro , Acampora Pina , Sajith Rincy , Nigro Rita , Boero Roberto , Scarpioni Roberto , Sicoli Rosa , Malandra Rosella , Aign Sabine , van Esch Sadie , Chapman Sally , Biribauer Sandra , Navjee Santee , Crosbie Sarah , Brown Sharon , Tickle Sheila , Manan Sherin , Röser Silke , Savoldi Silvana , Bertoli Silvio , Borrelli Silvio , Boorsma Siska , Heidenreich Stefan , Melander Stefan , Maxia Stefania , Maffei Stefano , Mangano Stefano , Palm Stephanie , Konings Constantijn , Mathavakkannan Suresh , Schwedler Susanne , Delrieux Sylke , Renker Sylvia , Schättel Sylvia , Dorota Szyszkowska , Cicchetti Teresa , Nieszporek Teresa , Stephan Theresa , Schmiedeke Thomas , Weinreich Thomas , Leimbach Til , Rappa Tiziana , Stövesand Torsten , Bahner Udo , Jensen Ulrika , Palazzo Valentina , De Simone Walter , Seeger Wolfgang , Kuan Ying , Heleniak Zbigniew , Aydin Zeynep 
Published: October 2019

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 m
2
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 m
2
lower) is independently associated with a steeper hs‐cTnT increase over time in the same range as other established cardiovascular risk factors.