Reviews address challenges of interpreting troponin levels in patients with chronic kidney disease

Two reviews being published in Annals of Internal Medicine address the challenges associated with using troponin levels to diagnose cardiac disease in patients with chronic kidney disease (CKD). Cardiac troponins (troponin I and T) are muscle contraction regulatory proteins found almost exclusively in the heart and are the most useful biomarkers of cardiac injury. Patients with CKD have a high prevalence of elevated serum troponin levels, even without cardiac disease, making it difficult to interpret their diagnostic and prognostic significance. Researchers conducted two systematic reviews of published evidence to evaluate the utility of troponin in both CKD patients with or without acute coronary syndrome (ACS). In the first paper, researchers systematically reviewed 98 observational studies to determine the prognostic value of troponin in patients who had CKD but not ACS. They found elevated levels of troponin I or troponin T were associated with worse prognosis. Specifically, patients with elevated troponin levels had a 2-4-fold higher risk for all-cause mortality, cardiovascular-specific mortality, and major adverse cardiac events.

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