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Serum cardiac biomarkers in patients with renal failure

Christopher deFilippi, MD, FACC
William L Henrich, MD, MACP
Section Editors
Jeffrey S Berns, MD
Allan S Jaffe, MD
Deputy Editor
Alice M Sheridan, MD


Cardiac biomarkers are used in conjunction with symptoms, electrocardiographic (ECG) changes, and cardiac imaging to diagnosis acute myocardial infarction (AMI) in patients with chronic kidney disease (CKD) [1]. Cardiac biomarkers are also used to predict short- and long-term adverse outcomes.

The principal cardiac biomarkers are cardiac troponin T (cTnT), cardiac troponin I (cTnI), and the MB isoenzyme of creatine kinase (CK-MB). (See "Troponin testing: Clinical use".)

This topic reviews the clinical use of cardiac troponins and CK-MB in patients with CKD. The use of these biomarkers in patients with normal renal function is discussed separately. (See "Troponin testing: Clinical use".)

The use of other enzymes in patients with CKD is discussed separately. (See "Serum enzymes in patients with renal failure".)

The risk of coronary artery disease (CAD) among dialysis and nondialysis patients with CKD is discussed separately. (See "Chronic kidney disease and coronary heart disease" and "Clinical manifestations and diagnosis of coronary heart disease in end-stage renal disease (dialysis)".)


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Literature review current through: May 2017. | This topic last updated: Jun 01, 2016.
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  1. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. J Am Coll Cardiol 2012; 60:1581.
  2. Freda BJ, Tang WH, Van Lente F, et al. Cardiac troponins in renal insufficiency: review and clinical implications. J Am Coll Cardiol 2002; 40:2065.
  3. Robitaille R, Lafrance JP, Leblanc M. Altered laboratory findings associated with end-stage renal disease. Semin Dial 2006; 19:373.
  4. Apple FS, Murakami MM, Pearce LA, Herzog CA. Predictive value of cardiac troponin I and T for subsequent death in end-stage renal disease. Circulation 2002; 106:2941.
  5. McLaurin MD, Apple FS, Voss EM, et al. Cardiac troponin I, cardiac troponin T, and creatine kinase MB in dialysis patients without ischemic heart disease: evidence of cardiac troponin T expression in skeletal muscle. Clin Chem 1997; 43:976.
  6. Haller C, Stevanovich A, Katus HA. Are cardiac troponins reliable serodiagnositic markers of cardiac ischaemia in end-stage renal disease? Nephrol Dial Transplant 1996; 11:941.
  7. Martin GS, Becker BN, Schulman G. Cardiac troponin-I accurately predicts myocardial injury in renal failure. Nephrol Dial Transplant 1998; 13:1709.
  8. Hafner G, Thome-Kromer B, Schaube J, et al. Cardiac troponins in serum in chronic renal failure. Clin Chem 1994; 40:1790.
  9. Twerenbold R, Wildi K, Jaeger C, et al. Optimal Cutoff Levels of More Sensitive Cardiac Troponin Assays for the Early Diagnosis of Myocardial Infarction in Patients With Renal Dysfunction. Circulation 2015; 131:2041.
  10. Stacy SR, Suarez-Cuervo C, Berger Z, et al. Role of troponin in patients with chronic kidney disease and suspected acute coronary syndrome: a systematic review. Ann Intern Med 2014; 161:502.
  11. Pfortmueller CA, Funk GC, Marti G, et al. Diagnostic performance of high-sensitive troponin T in patients with renal insufficiency. Am J Cardiol 2013; 112:1968.
  12. Chenevier-Gobeaux C, Meune C, Freund Y, et al. Influence of age and renal function on high-sensitivity cardiac troponin T diagnostic accuracy for the diagnosis of acute myocardial infarction. Am J Cardiol 2013; 111:1701.
  13. Newby LK, Jesse RL, Babb JD, et al. ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations: a report of the American College of Cardiology Foundation task force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2012; 60:2427.
  14. Adams JE 3rd, Bodor GS, Dávila-Román VG, et al. Cardiac troponin I. A marker with high specificity for cardiac injury. Circulation 1993; 88:101.
  15. Hafner G, Thome-Kromer B, Schaube J, et al. Cardiac troponins in serum in chronic renal failure. Clin Chem 1994; 40:1790.
  16. Frankel WL, Herold DA, Ziegler TW, Fitzgerald RL. Cardiac troponin T is elevated in asymptomatic patients with chronic renal failure. Am J Clin Pathol 1996; 106:118.
  17. McLaurin MD, Apple FS, Falahati A, et al. Cardiac troponin I and creatine kinase-MB mass to rule out myocardial injury in hospitalized patients with renal insufficiency. Am J Cardiol 1998; 82:973.
  18. McCullough PA, Nowak RM, Foreback C, et al. Performance of multiple cardiac biomarkers measured in the emergency department in patients with chronic kidney disease and chest pain. Acad Emerg Med 2002; 9:1389.
  19. deFilippi C, Seliger SL, Kelley W, et al. Interpreting cardiac troponin results from high-sensitivity assays in chronic kidney disease without acute coronary syndrome. Clin Chem 2012; 58:1342.
  20. Lamb EJ, Kenny C, Abbas NA, et al. Cardiac troponin I concentration is commonly increased in nondialysis patients with CKD: experience with a sensitive assay. Am J Kidney Dis 2007; 49:507.
  21. Morrow DA, Bonaca MP. Real-world application of "delta" troponin: diagnostic and prognostic implications. J Am Coll Cardiol 2013; 62:1239.
  22. Huang HL, Zhu S, Wang WQ, et al. Diagnosis of Acute Myocardial Infarction in Hemodialysis Patients With High-Sensitivity Cardiac Troponin T Assay. Arch Pathol Lab Med 2016; 140:75.
  23. Bjurman C, Larsson M, Johanson P, et al. Small changes in troponin T levels are common in patients with non-ST-segment elevation myocardial infarction and are linked to higher mortality. J Am Coll Cardiol 2013; 62:1231.
  24. Green TR, Golper TA, Swenson RD, et al. Diagnostic value of creatine kinase and creatine kinase MB isoenzyme in chronic hemodialysis patients: a longitudinal study. Clin Nephrol 1986; 25:22.
  25. Apple FS, Sharkey SW, Hoeft P, et al. Prognostic value of serum cardiac troponin I and T in chronic dialysis patients: a 1-year outcomes analysis. Am J Kidney Dis 1997; 29:399.
  26. Aviles RJ, Askari AT, Lindahl B, et al. Troponin T levels in patients with acute coronary syndromes, with or without renal dysfunction. N Engl J Med 2002; 346:2047.
  27. Dierkes J, Domröse U, Westphal S, et al. Cardiac troponin T predicts mortality in patients with end-stage renal disease. Circulation 2000; 102:1964.
  28. Deegan PB, Lafferty ME, Blumsohn A, et al. Prognostic value of troponin T in hemodialysis patients is independent of comorbidity. Kidney Int 2001; 60:2399.
  29. deFilippi C, Wasserman S, Rosanio S, et al. Cardiac troponin T and C-reactive protein for predicting prognosis, coronary atherosclerosis, and cardiomyopathy in patients undergoing long-term hemodialysis. JAMA 2003; 290:353.
  30. Wood GN, Keevil B, Gupta J, et al. Serum troponin T measurement in patients with chronic renal impairment predicts survival and vascular disease: a 2 year prospective study. Nephrol Dial Transplant 2003; 18:1610.
  31. Boulier A, Jaussent I, Terrier N, et al. Measurement of circulating troponin Ic enhances the prognostic value of C-reactive protein in haemodialysis patients. Nephrol Dial Transplant 2004; 19:2313.
  32. Iliou MC, Fumeron C, Benoit MO, et al. Prognostic value of cardiac markers in ESRD: Chronic Hemodialysis and New Cardiac Markers Evaluation (CHANCE) study. Am J Kidney Dis 2003; 42:513.
  33. Conway B, McLaughlin M, Sharpe P, Harty J. Use of cardiac troponin T in diagnosis and prognosis of cardiac events in patients on chronic haemodialysis. Nephrol Dial Transplant 2005; 20:2759.
  34. Khan NA, Hemmelgarn BR, Tonelli M, et al. Prognostic value of troponin T and I among asymptomatic patients with end-stage renal disease: a meta-analysis. Circulation 2005; 112:3088.
  35. Havekes B, van Manen JG, Krediet RT, et al. Serum troponin T concentration as a predictor of mortality in hemodialysis and peritoneal dialysis patients. Am J Kidney Dis 2006; 47:823.
  36. Wang AY, Lam CW, Yu CM, et al. Troponin T, left ventricular mass, and function are excellent predictors of cardiovascular congestion in peritoneal dialysis. Kidney Int 2006; 70:444.
  37. Hickson LJ, Cosio FG, El-Zoghby ZM, et al. Survival of patients on the kidney transplant wait list: relationship to cardiac troponin T. Am J Transplant 2008; 8:2352.
  38. Hayashi T, Obi Y, Kimura T, et al. Cardiac troponin T predicts occult coronary artery stenosis in patients with chronic kidney disease at the start of renal replacement therapy. Nephrol Dial Transplant 2008; 23:2936.
  39. Michos ED, Wilson LM, Yeh HC, et al. Prognostic value of cardiac troponin in patients with chronic kidney disease without suspected acute coronary syndrome: a systematic review and meta-analysis. Ann Intern Med 2014; 161:491.
  40. Hassan HC, Howlin K, Jefferys A, et al. High-sensitivity troponin as a predictor of cardiac events and mortality in the stable dialysis population. Clin Chem 2014; 60:389.
  41. McGill D, Talaulikar G, Potter JM, et al. Over time, high-sensitivity TnT replaces NT-proBNP as the most powerful predictor of death in patients with dialysis-dependent chronic renal failure. Clin Chim Acta 2010; 411:936.
  42. McMurray JJ, Uno H, Jarolim P, et al. Predictors of fatal and nonfatal cardiovascular events in patients with type 2 diabetes mellitus, chronic kidney disease, and anemia: an analysis of the Trial to Reduce cardiovascular Events with Aranesp (darbepoetin-alfa) Therapy (TREAT). Am Heart J 2011; 162:748.
  43. Dubin RF, Li Y, He J, et al. Predictors of high sensitivity cardiac troponin T in chronic kidney disease patients: a cross-sectional study in the chronic renal insufficiency cohort (CRIC). BMC Nephrol 2013; 14:229.
  44. Lentine KL, Costa SP, Weir MR, et al. Cardiac disease evaluation and management among kidney and liver transplantation candidates: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. J Am Coll Cardiol 2012; 60:434.
  45. Tun A, Khan IA, Win MT, et al. Specificity of cardiac troponin I and creatine kinase-MB isoenzyme in asymptomatic long-term hemodialysis patients and effect of hemodialysis on these cardiac markers. Cardiology 1998; 90:280.
  46. Lippi G, Tessitore N, Montagnana M, et al. Influence of sampling time and ultrafiltration coefficient of the dialysis membrane on cardiac troponin I and T. Arch Pathol Lab Med 2008; 132:72.
  47. Wayand D, Baum H, Schätzle G, et al. Cardiac troponin T and I in end-stage renal failure. Clin Chem 2000; 46:1345.