Over time, high-sensitivity TnT replaces NT-proBNP as the most powerful predictor of death in patients with dialysis-dependent chronic renal failure

• Published in: Clinica chimica acta Vol. 411; no. 13; pp. 936 - 939
• Main Authors: McGill, Darryl, Talaulikar, Girish, Potter, Julia M., Koerbin, Gus, Hickman, Peter E.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 04.07.2010
• Subjects: Biomarkers - metabolism; Cohort Studies; Death; Dialysis; Follow-Up Studies; Humans; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - metabolism; Kidney Failure, Chronic - therapy; Middle Aged; Natriuretic Peptide, Brain - metabolism; NT-proBNP; Peptide Fragments - metabolism; Prognosis; Renal Dialysis; Risk Factors; Time Factors; Troponin T; Troponin T - metabolism; Death; Dialysis; NT-proBNP; Troponin T
• ISSN: 0009-8981; 1873-3492
• DOI: 10.1016/j.cca.2010.03.004

Cardiac biomarkers are emerging as a potentially powerful prognostic tool for renal-dialysis patients. The optimal biomarker and/or combination of biomarkers for predicting mortality remain uncertain. This study evaluates the prognostic value of the new high-sensitivity troponin T (TnT) assay compared to established biomarkers. All patients had blood sampled for prospective assessment of the prognostic value of traditional risk markers including albumin and CRP, and cardiac biomarkers BNP, NT-proBNP, TnT and TnI. Patients were closely monitored clinically. Mortality and morbidity outcomes were documented for a national morbidity and mortality database. Stored samples were subsequently used to measure TnT with a new high-sensitivity assay. After a median of 30 months from blood collection, NT-proBNP was the most powerful predictor of all-cause mortality, along with albumin. After a median of 46.7 months the new high-sensitive TnT assay was the only cardiac biomarker predictive of all-cause mortality. TnT was detectable in all dialysis patients using the high-sensitive TnT assay with a cut-point of 24.15 ng/L below which all patients survived. The new hs-TnT is the most powerful biomarker for prognostic classification for all-cause mortality of all the commonly used biomarkers for our renal-dialysis population. Our study also suggests that cardiac biomarkers have a different prognostic ability for different time frames with NT-proBNP being a better predictor for early mortality and troponin for later mortality.