Troponin Has Prognostic Value in Chronic Kidney Disease

Second review shows value in CKD with suspected ACS, limited by variable sensitivity/specificity.
Second review shows value in CKD with suspected ACS, limited by variable sensitivity/specificity.

For patients with chronic kidney disease (CKD) without suspected acute coronary syndrome (ACS), troponin levels may have prognostic and diagnostic value, according to two reviews published online the Annals of Internal Medicine.

Erin D. Michos, MD, MHS, from the Johns Hopkins University School of Medicine in Baltimore, and colleagues conducted a systematic review of 98 observational studies to examine the prognostic value of troponin for patients with CKD without ACS.

Among patients receiving dialysis, elevated troponin levels correlated with all-cause and cardiovascular mortality. In pooled analyses, elevated troponin T was associated with a 3.0 and 3.3 increased risk for all-cause and cardiovascular mortality, respectively, and elevated troponin I was associated with a 2.7 and 4.2 times increased risk of these outcomes, respectively, after adjustment for age and coronary artery disease or a risk equivalent.

Sylvie R. Stacy, MD, MPH, from the Johns Hopkins University Bloomberg School of Public Health in Baltimore, and colleagues conducted a systematic review involving 23 studies to assess the utility of troponin in ACS diagnosis in patients with CKD with suspected ACS.

The researchers found that, for ACS diagnosis, the sensitivity and specificity of troponin T ranged from 71%-100% and from 31%-86%, respectively. For troponin I, the sensitivity and specificity ranged from 43%-94% and from 48%-100%, respectively. Elevated troponin I or troponin T levels correlated with increased risk of short-term death and cardiac events.

"Researchers should continue to try to determine optimal cut points for troponin levels in various patient populations and test management strategies based on these levels," according to the authors of an accompanying editorial.

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