Significance and Measurement of High-sensitivity Troponins I and T in Patients with Chronic Kidney Disease

Kronična bubrežna bolest (KBB) obilježena je postupnim i progresivnim gubitkom svih bubrežnih funkcija. Petina muškaraca i četvrtina žena u dobi nakon 65 godina boluje od KBBa. Uzimajući u obzir rastuću incidenciju dijabetesa i arterijske hipertenzije koji su glavni uzroci kroničnog gubitka bubrežne funkcije, može se zaključiti da KBB postaje globalni javnozdravsteni problem. Vodeći uzrok smrti u oboljelih od KBB-a jesu kardiovaskularne bolesti (KVB), i to ponajviše bolesti vezane uz srce poput ishemijske bolesti srca i srčanog zatajivanja. Visokoosjetljivi troponini (hs-cTnT, hs-cTnI) zlatni su standard u dijagnostici kardijalne patologije. Najčešće se rabe u detekciji akutnoga koronarnog sindroma, ali se povišene vrijednosti mogu zabilježiti u nizu drugih stanja. Poznato je da se povišene serumske vrijednosti troponina mogu zabilježiti u više od dvije trećine bolesnika s KBBom na dijalizi, čak i u odsutnosti KVB-a. Svrha je ovoga prikaza bila ustanoviti potencijalne uzroke porasta troponina u kroničnih bubrežnih bolesnika te zaključiti postoji li veza između njihova porasta i mortalitetnih i morbiditetnih pokazatelja. Pretraživanjem literature ustanovljeno je da su bolesnici u terminalnim stadijima bubrežnog zatajenja u znatno povišenom riziku za razvoj KVB-a i smrtnoga ishoda. Istraživanja su također upozorila na snažnu povezanost između koncentracije visokoosjetljivih troponina i kardiovaskularnog, odnosno ukupnog mortaliteta u oboljelih. S druge strane, malo se zna o načinu metaboliziranja i ekskrecije troponina. Teorija prema kojoj se troponini izlučuju bubrezima postaje sve prihvaćenija unutar znanstvenih krugova. Pojedina su istraživanja, od kojih i neka hrvatska, dokazala prisutnost troponina u urinu, no potrebna su i daljnja istraživanja kako bi se ustanovilo je li moguće iskoristiti troponine u urinu kao potencijalne nove biomarkere u pravodobnom prepoznavanju KBB-a i KVB-a.Chronic kidney disease (CKD) is characterized by gradual progressive loss of all kidney functions over a period of time. One-fifth of men and one-quarter of women over the age of 65 suffer from CKD. Given the growing incidence of diabetes and hypertension, which are the main causes of this disease, CKD is becoming one of the major global public health issues. Cardiovascular diseases are the leading cause of death in people with CKD, primarily heart-related conditions such as ischemic heart disease and heart failure. High-sensitivity troponins (hs-cTnT, hs-cTnI) are crucial biomarkers used in the detection of cardiac pathology. They are mostly used in the detection of acute coronary syndrome, but elevated values can be also observed in several other conditions. Studies have shown that serum troponin levels are elevated in more than two-thirds of patients with CKD on dialysis, even in those without any cardiovascular pathology. The aim of this review was to examine the literature and to determine the reason for troponin increase in patients with CKD, and to establish whether there is a connection between their increase and the mortality rate. A literature search revealed that patients with end-stage renal disease (ESRD) are at especially high risk of cardiovascular morbidity and mortality. Studies have also found a strong association of high-sensitivity troponins with cardiovascular and all-cause mortality in those patients. On the other hand, even though the function of troponins is very well-known, little is known about their production and excretion from the body. The theory that troponins are excreted by the kidneys is becoming widely accepted in scientific circles. New studies, some of which are Croatian, have demonstrated the presence of troponins in urine, but further research is needed to determine whether it is possible to use troponins in urine as potential biomarkers for cardiovascular and kidney disease