Cardiac Troponins in Kidney Disease

Cardiovascular disease is a major cause of morbidity and mortality in individuals with kidney disease. In recent years, biomarkers such as cardiac troponins have become indispensable to the diagnosis and prognosis of cardiac disease, such as MI and heart failure. However, these biomarkers behave differently in the general population compared with people with kidney disease, who may have higher baseline levels and reactions to acute disturbance due to a combination of reduced renal clearance of biomarker molecules and increased production due to concurrent cardiovascular disease and cardiorenal syndrome. Three decades of research into cardiac biomarkers have produced a range of literature investigating their applications in different patient groups and healthcare settings. This review explores the evidence surrounding measurement and interpretation of cardiac troponin levels in people who have chronic kidney disease, and have had dialysis and/or kidney transplantation, with reference to baseline levels and changes over time, their relationship to incident cardiovascular morbidity and mortality, and their application in acute settings.