Association of high-sensitivity cardiac troponin t and natriuretic peptide with incident ESRD: The atherosclerosis risk in communities (ARIC) study

Yuhree Kim, Kunihiro Matsushita, Yingying Sang, Morgan E. Grams, Hicham Skali, Amil M. Shah, Ron C. Hoogeveen, Scott D. Solomon, Christie M. Ballantyne, Josef Coresh

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Abstract

Background Epidemiologic data for cardiac abnormality predating decreased kidney function are sparse. We investigated the associations of high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) with end-stage renal disease (ESRD) risk in a community-based cohort. Study Design A prospective cohort study. Setting & Participants 10,749 white and black participants at the fourth visit (1996-1998) of the Atherosclerosis Risk in Communities (ARIC) Study with follow-up through 2010. Predictor hs-cTnT (3, 6, 9, and 14 ng/L) and NT-proBNP (41.6, 81.0, 142.5, and 272.5 pg/mL) levels were divided into 5 categories at the same percentiles (32th, 57th, 77th, and 91th; corresponding to ordinary thresholds of hs-cTnT), with the lowest category as a reference. Outcomes Incident ESRD defined as initiation of dialysis therapy, transplantation, or death due to kidney disease. Measurements Relative risk and risk prediction of ESRD according to hs-cTnT and NT-proBNP levels based on Cox proportional hazards models. Results During a median follow-up of 13.1 years, 235 participants developed ESRD (1.8 cases/1,000 person-years). hs-cTnT and NT-proBNP levels were associated with ESRD risk independently of each other and of potential confounders, including kidney function and albuminuria (adjusted HRs for highest category, 4.43 [95% CI, 2.43-8.09] and 2.28 [95% CI, 1.44-3.60], respectively). For hs-cTnT level, the association was significant even at the third category (HR for 6-8 ng/L of hs-cTnT, 2.74 [95% CI, 1.54-4.88]). Their associations were largely consistent even among persons without decreased kidney function or history of cardiovascular disease. hs-cTnT and NT-proBNP levels both significantly improved ESRD prediction (C statistic differences of 0.0084 [95% CI, 0.0005-0.0164] and 0.0045 [95% CI, 0.0004-0.0087], respectively, from 0.884 with conventional risk factors). Limitations Relatively small number of ESRD cases and single measurement of hs-cTnT and NT-proBNP. Conclusions hs-cTnT and NT-proBNP levels independently predicted ESRD risk in the general population, with more evident results for hs-cTnT. These results suggest the involvement of cardiac abnormality, particularly cardiac injury, in the progression of reduced kidney function and/or may reflect the useful property of hs-cTnT as an end-organ damage marker.

Original languageEnglish (US)
Pages (from-to)550-558
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume65
Issue number4
DOIs
StatePublished - Apr 1 2015

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Keywords

  • Atherosclerosis Risk in Communities (ARIC) Study.
  • High-sensitivity cardiac troponin T (hs-cTnT)
  • N-terminal probrain natriuretic peptide (NTproBNP)
  • cardiac injury
  • cardiac marker
  • incident end-stage renal disease (ESRD)
  • kidney disease progression
  • risk factor
  • risk prediction

ASJC Scopus subject areas

  • Nephrology

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