Cardiac troponins and renal failure: the evolution of a clinical test.

In this issue of Circulation, Khan and colleagues present the results of an elegantly performed meta-analysis of the prognostic implications of elevated levels of troponin T and I among asymptomatic patients with end-stage renal disease.1 After systematically collating the results of 28 cohort studies involving 3931 patients, they noted that an elevated troponin T level identified a group of end-stage renal disease patients with high mortality risk. Although elevated troponin I was also associated with increased risk, the exact effect size was difficult to assess because of a lack of standardization of current assays. The authors noted that despite the consistent association between elevated troponin T and mortality, the effect might be overestimated because of publication bias and study heterogeneity. Nonetheless, this meta-analysis, along with the specific reports of the largest published cohort studies,2,3 provides robust evidence that troponin T elevation in the setting of end-stage renal disease is ominous.