NDT Advance Access originally published online on May 13, 2008
Nephrology Dialysis Transplantation 2008 23(8):2707; doi:10.1093/ndt/gfn265
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Troponin T is an independent predictor of mortality in renal transplant recipients
E-mail: shrof010{at}umn.eduSir,
The article by Connolly et al. [1] is an important addition to the literature pertaining to cardiovascular disease (CVD) management of kidney transplant recipients. Although interesting, it is not an unexpected finding that higher levels of troponin T were associated with worse CVD outcomes in patients with a high CVD risk profile. In this study, patients with elevated troponin T levels (
0.03 µg/L) were older and had known CVD compared to patients without troponin T elevation. Similarly, kidney transplant recipients who died during follow-up were older, more likely to have diabetes or prior CVD compared to surviving patients. The presence of pre-existing coronary artery disease or congestive heart failure was not reported in the description of the study population. Increased age, diabetes, history of coronary artery disease, congestive heart failure and previous CVD are known to portend a poor prognosis in kidney transplant recipients [2,3], and patients with these CVD risk factors should undergo aggressive risk factor modification irrespective of their troponin level.
It would be extremely interesting, however, if the authors were able to stratify patients with elevated levels of troponin T (0.03 µg/L) into two groups (low and high risk) based on the presence or absence of known CVD risk factors [4]. It would be relevant for clinicians to know what proportion of ‘low risk’ patients had elevated troponin levels and died during follow-up in this study. ‘Low risk’ patients do not routinely undergo aggressive CVD risk factor modification. Thus, elevated troponin T levels in ‘low risk’ patients might help to identify a subgroup of patients that might benefit from aggressive CVD risk management.
Conflict of interest statement. None declared.
1 Division of Cardiology 2 Division of Nephrology, University of Minnesota, Minneapolis, MN, USA
References
- Connolly GM, Cunningham R, McNamee PT, et al. Troponin T is an independent predictor of mortality in renal transplant recipients. Nephrol Dial Transplant (2008) 23:1019–1025.
[Abstract/Free Full Text] - Pilmore H. Cardiac assessment for renal transplantation. Am J Transplant (2006) 6:659–665.[CrossRef][Web of Science][Medline]
- Kasiske BL, Cangro CB, Hariharan S, et al. The evaluation of renal transplantation candidates: clinical practice guidelines. Am J Transplant (2001) 1(Suppl_2):3–95.[Medline]
- Lewis MS, Wilson RA, Walker KW, et al. Validation of an algorithm for predicting cardiac events in renal transplant candidates. Am J Cardiol (2002) 89:847–850.[CrossRef][Web of Science][Medline]
Accepted in revised form: 17. 4.08
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