Prognostic Significance of Cardiac Troponin-T Level in Chronic Kidney Disease Patients on Hemodialysis

Abstract

Background: Cardiovascular complications are a major cause of mortality in chronic kidney patients (CKD) patients. More than 50% of patients of end-stage renal disease (ESRD) die due to these complication. Patients undergoing chronic hemodialysis (HD) presented with frequently elevated baseline values of cardiac troponin T (cTnT). Aim of the Study: The aim of this study was to estimate the level of cTnT in ESRD patients and to evaluate its diagnostic and prognostic value in HD patients. Materials and Methods: This was a case-control study carried over a period of 14 months. One hundred and one cases of CKD stage-V as per the KDIGO guidelines 2012 with eGFR ≤15 mL/min and 50 healthy control age-matched with a GFR ≥60 mL/min were included in the study. cTnT levels were measured at the start of the study, at 48 h and 6 months after completion of hemodialysis. Results: The mean age of the controls and cases were 45.74 ± 9.99 years and 47.77 ± 17.53 years, respectively. Of 101 cases, 40 cases had cTnT levels 0.10 ng/mL. Cardiac events were observed in 20 patients. Three patients died due to myocardial injury (cTnT levels >0.10 ng/mL) and 17 patients experienced cardiovascular events. These cardiovascular events were sudden cardiac deaths, stroke, atrial-ventricular block and congestive heart failure. Conclusion: All patients on chronic hemodialysis should be evaluated for annual measurement of serum cTnT, which could be used as a reference point. A small increase over time is common, but if any time levels more than double the baseline, which is uncommon, and if found indicate an acute coronary syndrome.