NDT Advance Access originally published online on May 13, 2008
Nephrology Dialysis Transplantation 2008 23(8):2707-2708; doi:10.1093/ndt/gfn269
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Reply
E-Mail: grainnemconnolly{at}aol.co.ukSir,
We would like to thank Drs Shroff and Kasiske for their comments. Traditional cardiovascular risk factors are associated with a poorer prognosis in renal transplant recipients [1]. However, the results from our study demonstrated that in multiple logistic regression analyses an elevated troponin T (TnT) level remained an independent predictor of all-cause mortality [2].
In response to the points raised by Drs Shroff and Kasiske, we stratified patients into high and low cardiovascular risk based on the presence of traditional cardiovascular risk factors (i.e. age >50 years, diabetes and smoking). Participants were classified as ‘low’ cardiovascular risk if they had 
1 risk factor and ‘high’ risk if they had 
2 risk factors. Of the 61 renal transplant recipients who had died at follow-up, 42 were identified as ‘low’ cardiovascular risk and 19 as ‘high’ cardiovascular risk.
We then assessed the utility of TnT level in relation to all cause mortality in the ‘high’ and ‘low’ cardiovascular risk groups. Of the 19 patients classified as ‘high’ cardiovascular risk 5 had an elevated TnT and 14 had a normal TnT. Interestingly, however, among the ‘low’ cardiovascular risk participants 7 had an elevated TnT and 35 had a normal TnT.
Although the numbers of patients are small, these data suggest that an elevated TnT in ‘low’ cardiovascular risk renal transplant recipients identifies a group who are at increased risk of all-cause mortality.
Undoubtedly, renal transplant recipients with high cardiovascular risk profiles should undergo aggressive risk-factor modification irrespective of their TnT level. However, the results of our study suggest that an elevated TnT level identifies a group of renal transplant recipients who are at increased risk of all-cause mortality and who may be overlooked if the risk assessment is based on the presence of traditional cardiovascular risk factors. TnT is a biochemical marker readily available in clinical practice that can enhance the current methods used to stratify risk in renal transplant recipients. An elevated TnT level can identify a subgroup of patients who may well benefit from more aggressive cardiovascular risk-factor modification.
Conflict of interest statement. None declared.
Department of Clinical Biochemistry, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK
References
- Kasiske BL. Epidemiology of cardiovascular disease after renal transplantation. Transplantation (2001) 72(Suppl_6):S5–S8.[Web of Science][Medline]
- 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.
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