Issue 165 Item 13Troponin and CRP Levels Predict Mortality in End-Stage Renal Di

The risk of death in patients with end-stage renal disease (ESRD), are directly related to serum levels of cardiac troponin T (cTnT) and C-reactive protein (CRP).

That, according to a report published in the July 16th issue of the Journal of the American Medical Association.
CRP and cTnT levels have been shown to be useful prognostic markers in acute coronary syndromes, the authors note. However, it was unclear if such levels would be meaningful in patients with impaired kidney function.

To investigate, Dr. Christopher deFilippi, from the University of Maryland School of Medicine in Baltimore, and colleagues evaluated the prognostic significance of cTnT and CRP levels in 224 ESRD patients without ischemic symptoms. The mean follow-up period was 827 days.

Fifty-two percent of patients died during follow-up, the authors note. As CRP and cTnT levels increased, the risk of death also increased. Compared with the lowest values, the highest CRP and cTnT levels were tied to a 1.8- and 3.0-fold increased risk of death, respectively.
A 2.5-fold increase in the risk of death was noted when levels of both markers were above median values, the researchers note.

Increased levels of cTnT, but not CRP, were strongly tied to diffuse coronary artery disease. For example, with the lowest cTnT levels diffuse disease was absent, while with the highest levels such disease was seen in 62% of patients.

The risk of having an ejection fraction of 40% or less increased as cTnT levels rose. This trend was not observed with CRP levels.
In ESRD patient without ischemic symptoms, "randomly assessed levels of cTnT and CRP independently identify patients at risk of death, and the combination of the 2 levels identify patients at particularly high risk," the investigators state.

"These findings identify a potential role for these markers to incorporated into future diagnostic and therapeutic strategies aimed at the earlier detection and management of clinically silent, but high-risk, diffuse coronary artery disease," they add.
JAMA 2003;290:353-359.

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FACT: Screening Strategies May Not Detect Early Renal Disease In Patients With Type 2 Diabetes.
About one-third of the adults in the United States with type 2 diabetes and a reduced glomerular filtration rate (GFR) have no albuminuria or diabetic retinopathy, which suggests that the current screening strategies for the early detection of renal disease in this patient population may not be sufficient. JAMA 2003;289:24:3273-3277