Department of Medical Informatics Academic Medical Center University of Amsterdam Amsterdam Public Health Research Institute Amsterdam The Netherlands.
Department of Medicine Karolinska Institutet Stockholm Sweden.
J Am Heart Assoc. 2019 Nov 5;8(21):e013091. doi: 10.1161/JAHA.119.013091. Epub 2019 Oct 30.
Background People with reduced glomerular filtration rate (GFR) often have elevated cardiac troponin T (cTnT) levels. It remains unclear how cTnT levels develop over time in those with chronic kidney disease (CKD). The aim of this study was to prospectively study the association between cTnT and GFR over time in older advanced-stage CKD patients not on dialysis. Methods and Results The EQUAL (European Quality Study) study is an observational prospective cohort study in stage 4 to 5 CKD patients aged ≥65 years not on dialysis (incident estimated GFR, <20 mL/min/1.73 m²). The EQUAL cohort used for the purpose of this study includes 171 patients followed in Sweden between April 2012 and December 2018. We used linear mixed models, adjusted for important groups of confounders, to investigate the effect of both measured GFR and estimated GFR on high-sensitivity cTnT (hs-cTnT) trajectory over 4 years. Almost all patients had at least 1 hs-cTnT measurement elevated above the 99th percentile of the general reference population (≤14 ng/L). On average, hs-cTnT increased by 16%/year (95% CI, 13-19; <0.0001). Each 15 mL/min/1.73 m lower mean estimated GFR was associated with a 23% (95% CI, 14-31; <0.0001) higher baseline hs-cTnT and 9% (95% CI, 5-13%; <0.0001) steeper increase in hs-cTnT. The effect of estimated GFR on hs-cTnT trajectory was somewhat lower than a previous myocardial infarction (15%), but higher than presence of diabetes mellitus (4%) and male sex (5%). Conclusions In CKD patients, hs-cTnT increases over time as renal function decreases. Lower CKD stage (each 15 mL/min/1.73 m lower) is independently associated with a steeper hs-cTnT increase over time in the same range as other established cardiovascular risk factors.
肾小球滤过率（GFR）降低的患者通常心肌肌钙蛋白 T（cTnT）水平升高。在未接受透析的慢性肾脏病（CKD）患者中，cTnT 水平随时间的变化尚不清楚。本研究旨在前瞻性研究未接受透析的老年晚期 CKD 患者中 cTnT 与 GFR 随时间的关系。
EQUAL（欧洲质量研究）研究是一项观察性前瞻性队列研究，纳入了年龄≥65 岁、未接受透析的 4 至 5 期 CKD 患者（新发估计肾小球滤过率<20 mL/min/1.73 m²）。本研究采用线性混合模型，根据重要的混杂因素调整，以研究测量 GFR 和估计 GFR 对 4 年内高敏肌钙蛋白 T（hs-cTnT）轨迹的影响。几乎所有患者均至少有 1 次 hs-cTnT 测量值高于一般参考人群第 99 百分位数（≤14 ng/L）。平均而言，hs-cTnT 每年增加 16%（95%CI，13-19；<0.0001）。估计 GFR 每降低 15 mL/min/1.73 m，基线 hs-cTnT 就会升高 23%（95%CI，14-31；<0.0001），hs-cTnT 升高斜率也会升高 9%（95%CI，5-13%；<0.0001）。估计 GFR 对 hs-cTnT 轨迹的影响略低于先前的心肌梗死（15%），但高于糖尿病（4%）和男性（5%）。
在 CKD 患者中，随着肾功能下降，hs-cTnT 随时间逐渐升高。在相同范围内，与其他已确立的心血管危险因素相比，CKD 分期较低（每 15 mL/min/1.73 m 降低）与 hs-cTnT 随时间的变化率增加更为相关。
