{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T10:43:53Z","timestamp":1793357033735,"version":"4.5.0"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2020,12,12]],"date-time":"2020-12-12T00:00:00Z","timestamp":1607731200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Baxter Healthcare Corporation to the Karolinska Institutet"},{"name":"Karolinska Institutet and Stockholm County Council"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Dialysis patients have a high prevalence of cardiovascular mortality but also elevated cardiac troponins (cTns) even without signs of cardiac ischaemia. The study aims to assess variation and prognostic value of high-sensitivity cTnI and cTnT in prevalent dialysis patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In 198 prevalent haemodialysis (HD) and 78 peritoneal dialysis (PD) patients, 4-monthly serum troponin I and T measurements were obtained. Reference change values (RCVs) were used for variability assessment and competing-risk regression models for survival analyses; maximal follow-up was 50\u2009months.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>HD and PD patients had similar troponin levels [median (interquartile range) troponin I: 25\u2009ng\/L (14\u201343) versus 21\u2009ng\/L (11\u201337), troponin T: 70\u2009ng\/L (44\u2013129) versus 67\u2009ng\/L (43\u2013123)]. Of troponin I and T levels, 42% versus 98% were above the decision level of myocardial infarction. RCVs were +68\/\u221241% (troponin I) and +29\/\u221223% (troponin T). Increased variability of troponins related to higher age, male sex, protein-energy wasting and congestive heart failure, but not ischaemic heart disease or dialysis form. Elevated troponin T, but not troponin I, predicted death after adjusting for confounders.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A large proportion of prevalent dialysis patients without current established or ongoing cardiac events have elevated levels of high-sensitivity cTns. Mortality risk was doubled in patients with persistently high troponin T levels. The large intraindividual variation of cTns suggests that serial measurements and reference change levels may be used to improve diagnostic utility. However, evidence-based recommendations require more data from large studies of dialysis patients with cardiac events.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ckj\/sfaa215","type":"journal-article","created":{"date-parts":[[2020,10,10]],"date-time":"2020-10-10T04:30:15Z","timestamp":1602304215000},"page":"1789-1797","source":"Crossref","is-referenced-by-count":24,"title":["High-sensitivity troponins in dialysis patients: variation and prognostic value"],"prefix":"10.1093","volume":"14","author":[{"given":"Sunna","family":"Snaedal","sequence":"first","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden"},{"name":"Landspitali University Hospital, Reykjavik, Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"B\u00e1r\u00e1ny","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigr\u00fan H","family":"Lund","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Iceland, Reykjavik, Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0536-5327","authenticated-orcid":false,"given":"Abdul R","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Department of Baxter Novum, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olof","family":"Heimb\u00fcrger","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Stenvinkel","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"L\u00f6wbeer","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Division of Clinical Chemistry, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Clinical Chemistry, SYNLAB Medilab, T\u00e4by, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karolina","family":"Szummer","sequence":"additional","affiliation":[{"name":"Department of Medicine (Huddinge), Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,12,12]]},"reference":[{"key":"2021063008553655400_sfaa215-B1","doi-asserted-by":"crossref","first-page":"2634","DOI":"10.1161\/CIRCULATIONAHA.107.187397","article-title":"Universal definition of myocardial infarction","volume":"116","author":"Thygesen","year":"2007","journal-title":"Circulation"},{"key":"2021063008553655400_sfaa215-B2","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1056\/NEJMoa0900428","article-title":"Early diagnosis of myocardial infarction with sensitive cardiac troponin assays","volume":"361","author":"Reichlin","year":"2009","journal-title":"N Engl J Med"},{"key":"2021063008553655400_sfaa215-B3","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.ahj.2014.10.007","article-title":"Comparison of conventional and high-sensitivity troponin in patients with chest pain: a collaborative meta-analysis","volume":"169","author":"Lipinski","year":"2015","journal-title":"Am Heart J"},{"key":"2021063008553655400_sfaa215-B4","doi-asserted-by":"crossref","first-page":"2041","DOI":"10.1161\/CIRCULATIONAHA.114.014245","article-title":"Optimal cutoff levels of more sensitive cardiac troponin assays for the early diagnosis of myocardial infarction in patients with renal dysfunction","volume":"131","author":"Twerenbold","year":"2015","journal-title":"Circulation"},{"key":"2021063008553655400_sfaa215-B5","doi-asserted-by":"crossref","first-page":"2759","DOI":"10.1093\/ndt\/gfi125","article-title":"Use of cardiac troponin T in diagnosis and prognosis of cardiac events in patients on chronic haemodialysis. 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