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

Overview

Journal Am J Kidney Dis

Specialty Nephrology

Date 2021 Jul 22

PMID 34293394

Citations 10

Authors

Nisha Bansal

Leila R Zelnick

Christie M Ballantyne

Paulo H M Chaves

Robert H Christenson

Josef Coresh

Christopher R deFilippi

James A de Lemos

Lori B Daniels

Alan S Go

Jiang He

S Susan Hedayati

Kunihiro Matsushita

Vijay Nambi

Michael G Shlipak

Jonathan J Taliercio

Stephen L Seliger

Affiliations

Soon will be listed here.

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 (125pg/mL) and hsTnT (14ng/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 <30mL/min/1.73m, 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 15mL/min/1.73m 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.

Citing Articles

Cardiac Troponin Levels in Patients with Chronic Kidney Disease: "Markers of High Risk or Just Noise''?.

Geladari E, Vallianou N, Evangelopoulos A, Koufopoulos P, Panagopoulos F, Margellou E Diagnostics (Basel). 2024; 14(20).

PMID: 39451639 PMC: 11507122. DOI: 10.3390/diagnostics14202316.

Kidney function-specific cut-off values of high-sensitivity cardiac troponin T for the diagnosis of acute myocardial infarction.

Chen R, Pang M, Yu H, Luo F, Zhang X, Su L Clin Kidney J. 2024; 17(9):sfae247.

PMID: 39246629 PMC: 11377898. DOI: 10.1093/ckj/sfae247.

Superiority of high sensitivity cardiac troponin I over NT-proBNP and adiponectin for 7-year mortality in stable patients receiving haemodialysis.

Iwamura N, Kidoguchi S, Asahi N, Takeda I, Matsuta K, Miyagi K Sci Rep. 2024; 14(1):11488.

PMID: 38769120 PMC: 11106234. DOI: 10.1038/s41598-024-62491-4.

Variation of NT-proBNP and High-Sensitivity Cardiac Troponin T Across Levels of Estimated Glomerular Filtration Rate: The SPRINT Trial.

Bansal N, Katz R, Seliger S, deFilippi C, Wettersten N, de Lemos J Circulation. 2024; 149(12):967-969.

PMID: 38498611 PMC: 10954091. DOI: 10.1161/CIRCULATIONAHA.123.066377.

Diagnostic value and utility of commonly used biomarkers of cardiac and renal function in cardiorenal syndromes: a narrative review.

Delalic D, Brezni T, Prkacin I Biochem Med (Zagreb). 2023; 33(3):030502.

PMID: 37545695 PMC: 10373058. DOI: 10.11613/BM.2023.030502.

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