Prognostic Utility of High-Sensitivity Cardiac Troponin I in Hemodialysis Patients Without Acute Coronary Syndrome: A Retrospective Cohort Study

Background and objectives In patients with end-stage kidney disease (ESKD) undergoing hemodialysis (HD), high-sensitivity cardiac troponin T (hs-cTnT) is a well-established biomarker for predicting all-cause and cardiovascular mortality. However, the prognostic utility of high-sensitivity cardiac troponin I (hs-cTnI) in this population remains uncertain. This study aimed to evaluate the association between hs-cTnI levels and one-year all-cause mortality in ESKD patients on HD presenting without suspected acute coronary syndrome (ACS). Materials and methods We performed a retrospective cohort study including 236 ESKD patients on HD admitted to a tertiary care hospital. hs-cTnI was measured within 24 hours of admission in the absence of clinical suspicion of ACS. Demographic, clinical, and laboratory data were collected. The primary outcome was all-cause mortality at one year. Multivariate logistic regression was used to assess the independent association between elevated hs-cTnI (above the 99th percentile) and mortality. Results A total of 236 patients were included. Elevated hs-cTnI was found in 133 (56.4%) patients, while 103 (43.6%) had non-elevated levels. One-year mortality was higher in the elevated group (43.6% [58/133]) than in the non-elevated group (27.1% [28/103]). However, after adjustment for potential confounders, elevated hs-cTnI was not independently associated with one-year mortality (adjusted odds ratio [aOR]: 1.73; 95% confidence interval [CI]: 0.97-3.08). Conclusions In ESKD patients on HD without suspected ACS, hs-cTnI measured within 24 hours of admission was not an independent predictor of one-year all-cause mortality. These findings suggest limited prognostic utility of hs-cTnI in this setting and support further investigation into the potential superiority of hs-cTnT in this population.