PMID- 28712855
DCOM- 20180612
LR  - 20180712
IS  - 1523-1755 (Electronic)
IS  - 0085-2538 (Linking)
VI  - 92
IP  - 5
DP  - 2017 Nov
TI  - Plasma high-sensitivity troponin T predicts end-stage renal disease and
      cardiovascular and all-cause mortality in patients with type 1 diabetes and
      diabetic nephropathy.
PG  - 1242-1248
LID - S0085-2538(17)30310-1 [pii]
LID - 10.1016/j.kint.2017.04.018 [doi]
AB  - High-sensitivity troponin T (hsTnT) is a marker of cardiovascular disease (CVD)
      and in type 2 diabetes also a marker of renal events, but has not been evaluated 
      in type 1 diabetics. We therefore reviewed a type 1 diabetes cohort of 442
      without and 458 with diabetic nephropathy. Baseline samples were analyzed for
      hsTnT levels. Cox regression analyses assessed predictive value in relation to
      the development of end-stage renal disease (ESRD) in 99 patients, all-cause
      mortality in 178, and CVD events in 134 after up to 12 years of follow-up. To
      assess if hsTnT improved risk prediction beyond traditional clinical risk
      markers, we calculated c statistics and relative integrated discrimination
      improvement. HsTnT was significantly higher in patients with diabetic nephropathy
      compared to normoalbuminuria (median 8.9 vs 3.1 ng/L). For a doubling in hsTnT
      levels, and after adjustment for well-known risk factors, including NT-proBNP and
      hsCRP, the hazard ratio for ESRD at 1.26 was not significant in the diabetic
      nephropathy group, but there was a significant association with GFR decline after
      adjustment during follow-up (2.9 ml/min/1.73 m(2) annual decline per doubling in 
      hsTnT). The unadjusted and adjusted hazard ratios for mortality (1.64 and 1.32,
      respectively) were significant in patients with, but not for patients without,
      nephropathy. Adjusted hazard ratios for fatal and non-fatal CVD events were
      significant for the whole cohort (1.13), and those with nephropathy (1.14), but
      not significant for normoalbuminuria (1.06). Addition of hsTNT to traditional
      risk factors significantly increased the area under the curve by 0.01 in a
      receiver-operating characteristic curve for mortality. The relative integrated
      discrimination improvement was increased 15.7% for mortality, 6.3% for CVD, and
      1.9% for ESRD (all significant). Thus, higher hsTnT is an independent predictor
      of renal decline and cardiovascular events in patients with type 1 diabetes and
      diabetic nephropathy.
CI  - Copyright (c) 2017 International Society of Nephrology. Published by Elsevier
      Inc. All rights reserved.
FAU - Galsgaard, Julie
AU  - Galsgaard J
AD  - Steno Diabetes Center Copenhagen, Gentofte, Denmark.
FAU - Persson, Frederik
AU  - Persson F
AD  - Steno Diabetes Center Copenhagen, Gentofte, Denmark. Electronic address:
FAU - Hansen, Tine Willum
AU  - Hansen TW
AD  - Steno Diabetes Center Copenhagen, Gentofte, Denmark.
FAU - Jorsal, Anders
AU  - Jorsal A
AD  - Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department
      of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
FAU - Tarnow, Lise
AU  - Tarnow L
AD  - Department of Clinical Research, Nordsjaellands Hospital Hillerod, Hillerod,
      Denmark; HEALTH, University of Aarhus, Aarhus, Denmark.
FAU - Parving, Hans-Henrik
AU  - Parving HH
AD  - HEALTH, University of Aarhus, Aarhus, Denmark; Department of Medical
      Endocrinology, Rigshospitalet, Copenhagen University Hospital, Copenhagen,
FAU - Rossing, Peter
AU  - Rossing P
AD  - Steno Diabetes Center Copenhagen, Gentofte, Denmark; HEALTH, University of
      Aarhus, Aarhus, Denmark; Institute for Clinical Medicine, University of
      Copenhagen, Copenhagen, Denmark.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20170714
PL  - United States
TA  - Kidney Int
JT  - Kidney international
JID - 0323470
RN  - 0 (Biomarkers)
RN  - 0 (Peptide Fragments)
RN  - 0 (Troponin T)
RN  - 0 (pro-brain natriuretic peptide (1-76))
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
RN  - 9007-41-4 (C-Reactive Protein)
SB  - IM
MH  - Adult
MH  - Biomarkers/blood
MH  - C-Reactive Protein/analysis
MH  - Cardiovascular Diseases/*blood/mortality
MH  - Diabetes Mellitus, Type 1/*blood/complications/mortality
MH  - Diabetic Nephropathies/*blood/etiology/mortality
MH  - Disease Progression
MH  - Female
MH  - Follow-Up Studies
MH  - Glomerular Filtration Rate
MH  - Humans
MH  - Kidney Failure, Chronic/*blood/diagnosis/mortality
MH  - Male
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain/blood
MH  - Peptide Fragments/blood
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Risk Assessment/methods
MH  - Risk Factors
MH  - Troponin T/*blood
OT  - *albuminuria
OT  - *cardiovascular disease
OT  - *chronic kidney disease
OT  - *diabetes
OT  - *diabetic nephropathy
EDAT- 2017/07/18 06:00
MHDA- 2018/06/13 06:00
CRDT- 2017/07/18 06:00
PHST- 2016/08/07 00:00 [received]
PHST- 2017/04/11 00:00 [revised]
PHST- 2017/04/13 00:00 [accepted]
PHST- 2017/07/18 06:00 [pubmed]
PHST- 2018/06/13 06:00 [medline]
PHST- 2017/07/18 06:00 [entrez]
AID - S0085-2538(17)30310-1 [pii]
AID - 10.1016/j.kint.2017.04.018 [doi]
PST - ppublish
SO  - Kidney Int. 2017 Nov;92(5):1242-1248. doi: 10.1016/j.kint.2017.04.018. Epub 2017 
      Jul 14.