T CHEN1, 5, H HASSAN2, 7, M VU4, 5, P Rao1, 5, A MAKRIS3, 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).
- 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.
- Adding hs-cTnT to traditional clinical parameters significantly improves the its prognostic performance.
- The frequency of hs-cTnT measurement should be at least yearly for PD. For HD patients, a less frequent measurement may be acceptable.