Key result
Impaired renal function did not fade the diurnal cardiac troponin T oscillation amplitude compared with reference subjects (11.4±0.5% vs 12.0±0.5%, P=0.53), excluding impaired renal elimination as the main cause of elevated troponin T in CKD.
Why the study?
Cardiac troponins are often persistently elevated in patients with CKD, but whether these elevations originate from increased cardiac release or decreased renal elimination was unknown, potentially delaying treatment for patients presenting with chest pain.
Does impaired renal function (chronic kidney disease) fade the diurnal oscillation rhythm of cardiac troponin T due to decreased renal elimination compared to preserved renal function?
Observational (n=44)
Does impaired renal function (chronic kidney disease) fade the diurnal oscillation rhythm of cardiac troponin T due to decreased renal elimination compared to preserved renal function?
Impaired renal elimination is not the main driver behind persistently elevated cardiac troponin T levels in chronic kidney disease, emphasizing that elevated troponin in these patients likely reflects myocardial injury and warrants diagnostic workup regardless of eGFR.
[Extract] Plasma concentrations of cardiac troponins, the preferred biomarkers for the diagnosis of acute myocardial infarction, are often persistently elevated in patients with chronic kidney disease (CKD). The origin of these elevations is unknown: Is it the heart, by increased release, or the kidneys, by decreased renal elimination? In clinical practice, this equivocal view on troponin elevations in patients with reduced glomerular clearance underlies countless clinical discussions among physicians and may delay rapid initiation of adequate treatment when these patients present with chest pain.
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Linden et al. (2017) conducted an observational in Chronic kidney disease (impaired renal function) (n=44). Impaired renal function (chronic kidney disease, eGFR <60 mL·min−1·1.73 m−2) vs. Reference subjects with normal renal function (median eGFR 82.8 mL·min−1·1.73 m−2) was evaluated on Diurnal cardiac troponin T oscillation amplitude (expressed as percent deviation from 24-hour mesor troponin concentration) (p=0.53). Impaired renal function did not fade the diurnal cardiac troponin T oscillation amplitude compared with reference subjects (11.4±0.5% vs 12.0±0.5%, P=0.53), excluding impaired renal elimination as the main cause of elevated troponin T in CKD.
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