Point of care assessment of cardiac troponin T level in CKD patients with chest symptom

Figures & data

Figure 1. Schema of study design.

Table 1. Characteristics of 201 patients with chest symptoms.

	Total	eGFR
		CKD1-2	CKD3	CKD4-5	CKD5D
Patients No.	201	52	78	38	33	p
Age, years	74 ± 14	66 ± 16	77 ± 12	79 ± 12	71 ± 11	<.001
Male, %	56	58	49	50	79	.025
Diabetes, %	29	23	22	37	48	.018
Dyslipidemia, %	45	52	47	47	24	.071
Pre-existing IHD, %	55	62	46	47	73	.073
Pre-existing CVD, %	16	8	19	21	15	.261
Symptom, %						.002
Shock	10.0	11.5	10.3	10.5	6.1
Chest pain/chest discomfort	32.9	55.7	23.0	23.7	30.4
Dyspnea	43.8	17.3	50.0	57.9	54.5
Backpain	3.5	3.8	6.4	0.0	0.0
Palpitation	7.0	9.6	6.4	5.3	6.1
Others	3.0	1.9	3.8	2.6	3.0
BMI, kg/m^2	22 ± 4	23 ± 4	22 ± 4	22 ± 4	20 ± 3	.031
Systolic BP, mmHg	136 ± 33	135 ± 31	135 ± 32	139 ± 36	138 ± 35	.900
Diastolic BP, mmHg	73 ± 16	74 ± 14	73 ± 17	70 ± 16	73 ± 15	.756
Heart rate, beats/min	84 ± 26	85 ± 27	83 ± 25	82 ± 26	88 ± 26	.728
Ejection fraction (%)	56 ± 15	59 ± 14	55 ± 15	55 ± 15	53 ± 16	.456
Creatine kinase, mg/dL	206 ± 414	188 ± 289	232 ± 559	271 ± 370	100 ± 99	.330
Urea, mg/dL	30 ± 23	15 ± 4	21 ± 7	59 ± 31	39 ± 19	<.001
Creatinine, mg/dL	2.6 ± 3.0	0.7 ± 0.1	1.1 ± 0.2	4.2 ± 3.3	7.1 ± 3.0	<.001
eGFR, mL/min/1.73^2	42 ± 27	75 ± 14	46 ± 8	15 ± 8	7 ± 3	<.001
NT-ProBNP, median (IQR)	2933 (870, 9246)	620 (147, 2852)	2553 (907, 4429)	6665 (2175, 24,586)	27,267 (11,157, 49,160)	<.001
Medications
CCB, %	43	29	36	66	55	.001
RAS-I, %	50	35	45	76	55	.001
Statin, %	33	29	37	39	21	.285
Anti-platelet agents, %	41	19	45	39	67	<.001
Beta blocker, %	33	17	24	53	55	<.001
ACE, %	38	52	35	24	42	.041

CKD: chronic kidney disease; IHD: ischemic heart disease; CVD: cerebrovascular disease; BMI: body mass index; BP: blood pressure; eGFR: estimated glomerular filtration rate; CCB: calcium channel blocker.

Table 2. Distribution of patients in categorical cTnT levels.

		CKD1-2	CKD3	CKD4-5	CKD5D
Patients No.	201	52	78	38	33
cTnT^a, ng/mL	0.29 ± 0.57	0.19 ± 0.40	0.25 ± 0.54	0.27 ± 0.58	0.55 ± 0.78	0.030
cTnT group						<0.001
cTnT <0.03 ng/mL, %	49.3	59.6	60.3	36.8	21.2
cTnT 0.03-<0.1 ng/mL, %	20.9	13.5	15.4	36.8	27.3
cTnT 0.1-<2.0 ng/mL, %	23.4	26.9	19.2	18.4	33.3
cTnT >2.0 ng/mL, %	6.5	0	5.1	7.9	18.2

cTnT: cardiac toroponin T; CKD: chronic kidney disease.

^aExcept of TnT quantitative range 0.1–2.0 ng/mL, dummy numerical values 0.029, 0.065, and 0.201 ng/mL were used for categorical range <0.03 ng/mL, 0.03–0.10 ng/mL, and >2.0 ng/mL, respectively.

Table 3. Distribution of patients with ACEs in each categorical part of cTnT.

		Categorized cTnT (ng/mL)
	ACEs	<0.03	0.03-0.1	0.1-2.0	>2.0	p
Total	(−)	74.7	73.8	36.2	15.4	<.001
	(+)	25.3	26.2	63.8	84.6
CKD1-2	(−)	64.5	28.6	21.4		.015
	(+)	35.5	71.4	78.6
CKD3	(−)	73.6	91.7	26.7	0	<.001
	(+)	23.4	8.3	73.3	100
CKD4-5	(−)	85.7	92.9	57.1	0	.003
	(+)	14.3	7.1	42.9	100
CKD5D	(−)	85.7	55.6	54.5	33.3	.288
	(+)	14.3	44.4	45.5	66.7

cTnT: cardiac toroponin T; CKD: chronic kidney disease.

Table 4. Cutoff value of cTnT for ACE in CKD patient groups.

	Cutoff value (ng/mL)	AUC	95% CI	p	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)
CKD 1-2	0.047	0.688	0.540–0.837	.02	59.3	80.0	76.2	64.5
CKD 3	0.088	0.713	0.580–0.846	.002	55.6	92.2	78.9	79.7
CKD 4-5	0.18	0.768	0.548–0.989	.016	66.7	89.7	66.7	89.7
CKD 5D	0.27	0.712	0.531–0.893	.04	64.3	78.9	69.2	75.0

CKD: chronic kidney disease; AUC: area under the curve; CI: confidential interval; PPV: positive predictive value; NPV: negative predictive value.

Table 5. Diagnostic value of cTnT 0.1 ng/mL for ACE in CKD patient groups.

	Cutoff value,(ng/mL)	Sensitivity(%)	Specificity(%)	PPV(%)	NPV(%)
CKD 1-2	0.1	40.7	88.0	78.6	57.9
CKD 3	0.1	55.6	92.2	78.9	79.7
CKD 4-5	0.1	66.7	86.2	60.0	89.3
CKD 5D	0.1	64.3	57.9	52.9	68.8

CKD: chronic kidney disease; PPV: positive predictive value; NPV: negative predictive value.