Upper Reference Limits for High-Sensitivity Cardiac Troponin T and N-Terminal Fragment of the Prohormone Brain Natriuretic Peptide in Patients With CKD

CRIC Study Investigators

Research output: Contribution to journalArticlepeer-review

Abstract

Rationale & Objective: The utility of conventional upper reference limits (URL) for N-terminal pro–brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hsTnT) in chronic kidney disease (CKD) remains debated. We analyzed the distribution of hsTnT and NT-proBNP in people with CKD in ambulatory settings to examine the diagnostic value of conventional URL in this population. Study Design: Observational study. Setting & Participants: We studied participants of the Chronic Renal Insufficiency Cohort (CRIC) with CKD and no self-reported history of cardiovascular disease. Exposure: Estimated glomerular filtration rate (eGFR). Outcome: NT-proBNP and hsTnT at baseline. Analytical Approach: We described the proportion of participants above the conventional URL for NT-proBNP (125 pg/mL) and hsTnT (14 ng/L) overall and by eGFR. We then estimated 99th percentile URL for NT-proBNP and hsTnT. Using quantile regression of the 99th percentile, we modeled the association of eGFR with NT-proBNP and hsTnT. Results: Among 2,312 CKD participants, 40% and 43% had levels of NT-proBNP and hsTnT above the conventional URL, respectively. In those with eGFR < 30 mL/min/1.73 m2, 71% and 68% of participants had concentrations of NT-proBNP and hsTnT above the conventional URL, respectively. Among all CKD participants, the 99th percentile for NT-proBNP was 3,592 (95% CI, 2,470-4,849) pg/mL and for hsTnT it was 126 (95% CI, 100-144) ng/L. Each 15 mL/min/1.73 m2 decrement in eGFR was associated with a ~40% higher threshold for the 99th percentile of NT-proBNP (1.43 [95% CI, 1.21-1.69]) and hsTnT (1.45 [95% CI, 1.31-1.60]). Limitations: Study included ambulatory patients, and we could not test the accuracy of the URL of NT-proBNP and hsTnT in the acute care setting. Conclusions: In this ambulatory CKD population with no self-reported history of cardiovascular disease, a range of 40%-88% of participants had concentrations of NT-proBNP and hsTnT above the conventional URL, depending on eGFR strata. Developing eGFR-specific thresholds for these commonly used cardiac biomarkers in the setting of CKD may improve their utility for evaluation of suspected heart failure and myocardial infarction.

Original languageEnglish (US)
JournalAmerican Journal of Kidney Diseases
DOIs
StateAccepted/In press - 2021
Externally publishedYes

Keywords

  • Cardiac biomarkers
  • N-terminal pro–brain natriuretic peptide (NT-proBNP)
  • cardiovascular disease
  • chronic kidney disease (CKD)
  • diagnostic threshold
  • heart failure (HF)
  • high-sensitivity cardiac troponin T (hsTnT)
  • laboratory measurement
  • myocardial infarction (MI)
  • troponin
  • upper limit of normal (ULN)

ASJC Scopus subject areas

  • Nephrology

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