Nephrol Dial Transplant (2002) 17: 2178-2183
© 2002 European Renal Association-European Dialysis and Transplant Association
Elevated cardiac troponin T in peritoneal dialysis patients is associated with CRP and predicts all-cause mortality and cardiac death
1 Division of Clinical Chemistry, Department of Medical Laboratory Sciences and Technology, 2 Division of Renal Medicine, Department of Clinical Science, Karolinska Institutet at Huddinge University Hospital and 3 Department of Medicine, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden
Background. Cardiac troponin T (cTnT) is a highly sensitive and specific marker of myocardial damage. In sera from patients with end-stage renal disease, cTnT may be elevated without other signs of acute myocardial injury. It has been shown that elevated cTnT in haemodialysis patients is associated with poor prognostic outcome. The aim of the present study was to test the hypothesis that elevated cTnT in a single serum sample from peritoneal dialysis (PD) patients is of prognostic importance.
Methods. Blood samples were taken from 26 randomly selected PD patients without signs of acute myocardial ischaemia. Sera were analysed for: cTnT with the second generation TnT ELISA on ES 300; cardiac troponin I (cTnI) with Opus Plus; and for creatine kinase-MB (CKMB) mass and C-reactive protein (CRP). After 4 years, clinical outcomes were evaluated by chart review. The influence on survival was tested with Kaplan–Meier analysis and Cox's proportional regression analysis.
Results. Concentrations of cTnT 
0.04 µg/l and CRP 10 mg/l were strong predictors of all-cause mortality in univariate analysis. Twelve out of 14 patients with cTnT 0.04 µg/l died compared with three out of 12 with cTnT <0.04 µg/l. Other factors that influenced survival were age and the presence of ischaemic heart disease (IHD). There was a significant positive correlation between cTnT and CRP, and between cTnT and age. Cardiac troponin T was an independent predictor compared with age but not compared with CRP and IHD. Neither cTnI nor CKMB mass concentrations were related to survival.
Conclusion. Elevated serum concentrations of cTnT significantly predicted poor outcome and there was a correlation between cTnT and CRP concentrations in samples from PD patients. Cardiac troponin I and CKMB mass had no prognostic value.
Keywords: cardiac troponin; C-reactive protein; creatine kinase isoenzymes; peritoneal dialysis; survival
Correspondence and offprint requests to: Christian Löwbeer MD, Department of Clinical Chemistry, Huddinge University Hospital, S-141 86 Stockholm, Sweden. Email: christian.lowbeer{at}chemlab.hs.sll.se
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