Highly-sensitive Troponin T in a cohort of Indigenous Australian adults with and without Diabetes and Chronic Kidney Disease — ASN Events
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Highly-sensitive Troponin T in a cohort of Indigenous Australian adults with and without Diabetes and Chronic Kidney Disease (#201)

Jaqui T Hughes 1 2 , Hang D Nguyen 2 , Federica Barzi 1 3 , Alex Brown 3 4 , Paul D Lawton 1 , Graham RD Jones 5 , Zhong X Lu 6 , Ashim Sinha 7 , Alan Cass 1 , Wendy E Hoy 8 , Kerin O'Dea 3 , George Jerums 9 10 , Richard MacIsaac 11 , Louise J Maple-Brown 1 2 , on behalf of the Investigators of The eGFR Study
  1. Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
  2. Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
  3. University of South Australia, Adelaide, South Australia, Australia
  4. South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
  5. SydPath, St Vincent's Hospital, Sydney, New South Wales, Australia
  6. Melbourne Pathology, Melbourne, Victoria, Australia
  7. Cairns Base Hospital and Diabetes Centre, Cairns, Queensland, Australia
  8. University of Queensland, Brisbane, Queensland, Australia
  9. Austin Health, Melbourne, Victoria, Australia
  10. University of Melbourne, Melbourne, Victoria, Australia
  11. Department of Endocrinology and Diabetes, St. Vincent's Hospital, Melbourne, Victoria, Australia

Background: Chronic kidney disease (CKD) is much more prevalent in the Indigenous than non-Indigenous Australians. Cardiovascular disease (CVD) is the leading cause of mortality in patients with CKD1 . Cardiac troponin elevations are associated with increased CVD, are frequent in patients with CKD, and are associated with increased mortality in patients with CKD2 3 . This study was aimed to examine the associations between highly sensitive troponin T (hsTnT) levels, CKD and cardiovascular risk factors in the Indigenous Australian population.

Method: Cross-sectional study of asymptomatic Indigenous Australian adults from Central and Northern Australia participating in The eGFR Study. Serum hsTnT was analysed with electro-chemiluminescence immunoassay (Roche Diagnostics, Mannheim); lower limit of detection was 3ng/L and normal hsTnT defined as less than 15ng/L.

Results: Of 604 Indigenous Australian adults (40% with diabetes), the following were significantly different across troponin groups [hsTnT ≤ 3 (n=429), between 3-15 (n=125), ≥15ng/L (n=50)] with p<0.001: age (40, 54, 56 years); female gender (68%, 49%, 48%); waist-hip ratio (0.92, 0.98, 0.99); systolic blood pressure (115, 124, 125 mmHg); proportion with diabetes (28%, 60%, 86%); HbA1c (46, 55, 65 mmol/mol); and CKD-EPI eGFR (104, 76, 42 mls/min/1.73m2). On age and gender adjusted logistic regression analyses of hsTnT ≥15 ng/L, the factors associated with higher hsTnT were age OR 1.06 (95%CI: 1.04-1.09), diabetes OR 7.15 (95%CI 3.06-16.7), HDL-cholesterol OR 0.24 (95%CI 0.07-0.81) and eGFR < 60ml/min/1.73m2 OR 106.8 (95%CI: 28.3-403.9). On multiple logistic regression analyses the following remained independently associated with higher hsTnT: diabetes OR 9.42 (95%CI 3.10-28.7), male gender OR 3.33 (1.30-8.52), eGFR < 60ml/min/1.73m2 OR 127.1 (95%CI 30.4 – 531.5).

 Conclusion: Diabetes and lower eGFR were independently associated with higher serum hsTnT levels in this cross-sectional study of Indigenous Australian adults, similar to other population studies4 . Longitudinal studies are required to evaluate if higher troponins are associated with increased CVD and all cause mortality in Indigenous Australian populations.

  1. Australian Institute of Health and Welfare 2011. Chronic kidney disease in Aboriginal and Torres Strait Islander people 2011. Cat. no. PHE 151 Canberra: AIHW. Available from:http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737420068. [1 June 2015]
  2. Michos ED, Wilson LM, Yeh HC, Berger Z et al, 2014, ‘Prognostic Value of Cardiac Troponin in Patients with Chronic Kidney Disease without Suspected Acute Coronary Syndrome: A Systematic Review and Meta-analysis’, Annals of Internal Medicine, 161(7):491-502
  3. Weiner DE, Tabatabai S, Tighiouart H, Elsayed E et al, 2006, ‘Cardiovascular outcomes and All-Cause Mortality: Exploring Interaction between CKD and Cardiovascular Disease’, American Journal of Kidney Diseases, 48(3):392-401
  4. Saunders JT, Nambi V, de Lemos JA, Chambless LE et al, 2011, ‘Cardiac Troponin T measured by a highly sensitive assay predicts coronary heart disease, heart failure, and mortality in the ARIC study’, Circulation, 123(13): 1367–1376