Evaluating high-sensitivity Troponin T thresholds and their association with cardiovascular mortality in hemodialysis patients

Background: Cardiac troponin (c-TnT) levels are considered the gold standard for diagnosing acute coronary syndrome (ACS), particularly with the advent of high-sensitivity assays (hs-TnT). However, its increased sensitivity can reduce specificity, particularly in patients with chronic kidney disease (CKD). This study aims to evaluate the baseline hs-TnT levels in patients with chronic kidney disease (CKD) on hemodialysis and identify variables associated with worse cardiovascular outcomes. Methods A prospective cohort study was conducted with CKD patients undergoing hemodialysis at a reference center in Brazil, followed for 24 months. Baseline hs-TnT levels were measured before and after dialysis, and data on comorbidities and cardiovascular events were collected. Statistical analysis identified associations between hs-TnT levels and mortality. Results Of 136 enrolled patients, 88 completed the study, with a mean age of 67 years, predominantly male.. TElevated pre-dialysis hs-TnT levels were observed in most patients, particularly those with a history of coronary artery disease (CAD) and diabetes. Elevated pre-dialysis troponin levels were significantly associated with increased risk of cardiovascular mortality within 24 months. A cutoff of 83.3 ng/L for hs-TnT demonstrated a sensitivity of 75%, specificity of 80.9%, and accuracy of 79.5% for predicting mortality within two years. After adjusting for confounders, patients with pre-dialysis hs-TnT levels ≥ 83.3 ng/L had a 10-fold increased risk of cardiovascular death and a 6-fold increased risk of all-cause mortality. Conclusions Baseline hs-TnT levels ≥ 83.3 ng/L in CKD patients on hemodialysis predict increased cardiovascular and overall mortality. Establishing baseline hs-TnT levels in CKD patients undergoing hemodialysis is essential for early detection of ACS and the identification of high-risk individuals.