HIGH-SENSITIVITY CARDIAC TROPONIN T AND C-REACTIVE PROTEIN HAVE DIFFERENT PROGNOSTIC VALUES IN HAEMO- AND PERITONEAL DIALYSIS POPULATION: A COHORT STUDY

T CHEN^{1, 5}, H HASSAN^{2, 7}, M VU^{4, 5}, P Rao^{1, 5}_, A MAKRIS^{3, 6}

¹The Westmead Institute for Medical Research, Westmead, NSW; ²Wollongong Hospital, Wollongong, NSW; ³Liverpool Hospital, Liverpool, NSW; ⁴Royal Prince Alfred Hospital, Camperdown, NSW; ⁵University of Sydney, Camperdown, NSW; ⁶University of New South Wales, Kensington, NSW; ⁷University of Wollongong, Wollongong, NSW

Aim: To evaluate the prognostic value of high sensitivity cardiac troponin T (hs-cTnT) and C-reactive protein (CRP) in stable haemodialysis (HD) and peritoneal dialysis (PD) patients.

Background: In dialysis population, clinical assessment based on traditional risk factors is inadequate in identifying patients at high risk of adverse outcome. Serum biomarkers can be a useful tool in risk stratification of this population.

Methods: A 3.5-year retrospective observational study of a cohort of 574 HD (n=347) and PD (n=227) patients. All-cause mortality and major adverse cardiovascular events (MACE) were assessed. SPSSv23 was used, P<0.05 was significant.

Results: No patient was lost to follow up. For HD patients, hs-cTnT remained relatively stable for the follow up period. For PD patients, hs-cTnT increased significantly every year (P<0.001).

High-sensitivity cardiac troponin T was an independent predictor of both outcomes in HD and PD patients. C-reactive protein was an independent predictor of both outcomes in PD patients only. Performing CRP in addition to hs-cTnT further improved risk prediction. The area under the receiver operating curves (AUC) for hs-cTnT (mortality AUC=0.706, MACE AUC=0.62) and traditional clinical parameters (mortality AUC=0.703, MACE AUC=0.634) were similar and they were larger than CRP (mortality AUC=0.591, MACE AUC=0.523). Adding hs-cTnT to traditional clinical parameters significantly increased its AUC (P=0.018).

Conclusions:

1. Both hs-cTnT and CRP have a useful role in predicting adverse outcomes in dialysis patients at 3.5 years. Their prognostic performance is different in HD and PD patients.
2. Adding hs-cTnT to traditional clinical parameters significantly improves the its prognostic performance.
3. The frequency of hs-cTnT measurement should be at least yearly for PD. For HD patients, a less frequent measurement may be acceptable.