Kidney Week

Abstract: SA-PO775

Patterns of Troponin Elevation in Patients with CKD and Long-Term Mortality Risk After Progression to ESRD

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - III
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• George, Lekha K., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Lekha K. George,

• Koshy, Santhosh K., Regional One Health - University of TN Health Sciences Ctr, Memphis, Tennessee, United States

Santhosh K. Koshy,

• Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Miklos Zsolt Molnar,

• Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Praveen Kumar Potukuchi,

• Agarwal, Manyoo, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Manyoo Agarwal,

• George, Koshy K., University of Queensland, Memphis, Tennessee, United States

Koshy K. George,

• Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States

Kamyar Kalantar-Zadeh,

• Kovesdy, Csaba P., Memphis VA Medical Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

Background

Elevated troponin as a marker of myocardial infarction is associated with poor short and long term mortality. Chronic kidney disease is commonly associated with higher and sustained levels of troponin due to reduced clearance. It is not known if the pattern of troponin elevation in patients with advanced CKD confers higher mortality risk after starting dialysis.

Methods

We examined 16,563 US veterans who had troponin levels measured during the 3 years prior to start of dialysis. We examined associations of 24-hour slope of troponin elevation, maximum troponin level, and the absolute value and percentage of the difference between the maximum and minimum troponin levels with all-cause mortality in Cox models adjusted for demographics, comorbidities, smoking status, blood pressure, BMI and baseline eGFR.

Results

Patients were 66±10 years old, 97% male, 37% African-American, 77% diabetic, and 67%, 69% and 41% had histories of ischemic heart disease, congestive heart failure and cerebrovascular disease, respectively. 11,196 patients died (mortality rate: 243/1000 patient-years, 95%CI: 238-248) over a median follow-up of 2.43 years after starting dialysis. Steeper rise in troponin level over 24 hours was not associated with higher mortality (Figure). Higher levels of maximum troponin level were associated with significantly higher mortality, whereas a higher absolute and percentage difference between maximum and minimum troponin levels was less consistently associated with increased mortality (Figure).

Conclusion

Elevated troponin in patients with advanced stage CKD is associated with higher risk of mortality after initiation of dialysis. Higher levels of maximum troponin values show the most consistent association with higher mortality, whereas the rate of troponin rise over a 24-hour period is not associated with long term mortality.

Funding

• NIDDK Support