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NDT Advance Access published online on July 13, 2004
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh365
© 2004 by European Renal Association - European Dialysis and Transplant Association
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Received November 25, 2003
Accepted March 31, 2004

Original Article

Measurement of circulating troponin Ic enhances the prognostic value of C-reactive protein in haemodialysis patients

Alexandre Boulier 1, Isabelle Jaussent 2, Nathalie Terrier 1, François Maurice 3, Jean-Pierre Rivory 3, Lotfi Chalabi 4, Anne-Marie Boularan 1, Cécile Delcourt 2, Anne-Marie Dupuy 1, Bernard Canaud 5, Jean-Paul Cristol 1*

1 Biochemistry Laboratory, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
2 INSERM Unité 500 ‘Epidemiology of chronic diseases and ageing’, Montpellier, France
3 Centre Hémodialyse Languedoc Méditerranée, Montpellier, France
4 AIDER, Montpellier, France
5 Nephrologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France; AIDER, Montpellier, France; Renal Research and Training Institute, Montpellier, France

* To whom correspondence should be addressed. E-mail: jp-cristol{at}chu-montpellier.fr.



  Abstract

Background. Cardiac Troponin I (cTnI) levels are considered an important diagnostic tool in acute coronary events. They could be of predictive value in haemodialysis (HD) patients. However, the relationship between cTnI and the HD-induced inflammatory state remains unclear. The aim of this study was to explore the prognostic relevance to all-cause and cardiovascular mortalities in HD patients of cTnI, in combination with highly sensitive C-reactive protein (hs-CRP) levels.

Methods. We measured cTnI and hs-CRP at baseline (March 10 to November 16, 2001) in 191 HD patients without clinical signs of acute coronary artery disease [median age 66.7 years (range 22.3-93.5), 94 females, 97 males]. We used a cTnI concentration with a total imprecision of 10% (0.03 µg/l), determined in the laboratory, as the analytical threshold value. Patients were followed for mortality until 1 January, 2003 (median follow-up 418 days). The adjusted relative risks (RRs) of death and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models.

Results. A significant proportion (25.1%) of patients had elevated CTnl, ≥0.03 µg/l; 40.3% of patients had CRP concentrations ≥10 mg/l. During follow-up, 29 patients died, 44.8% due to cardiac causes. Elevated cTnI or CRP levels were associated with increased mortality [RR adjusted for age, sex and duration of dialysis 4.2 (1.9-9.0) for cTnI ≥0.03 µg/l and 3.6 (1.6-8.1) for CRP ≥10 mg/l], cTnI being particularly predictive of cardiovascular death. Moreover, the combination of elevated hs-CRP (≥10 mg/l) and circulating cTnI (≥0.03 µg/l) dramatically impaired the HD survival rate [adjusted RR for all-cause mortality 16.9 (4.5-63.8)].

Conclusion. Circulating cTnI was associated with poor prognosis, especially when combined with elevated CRP, strongly supporting the adoption of regular cTnI testing in HD patients.

Keywords: cardiovascular disease; haemodialysis; mortality; troponin.
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