Association between high-sensitivity troponin T levels below the ninety-ninth percentile and diabetic kidney disease: A cross-sectional study.

Abstract

Background: Identification of myocardial injury has traditionally relied on high-sensitivity troponin T (hs-TnT) levels exceeding the 99^th percentile threshold. However, patients with detectable hs-TnT levels below this threshold represent a heterogeneous group with an inadequately characterized risk profile.

Aim: To investigate the association between hs-TnT levels below the 99^th percentile and the presence of diabetic kidney disease (DKD) in patients with diabetes mellitus.

Methods: This study analyzed data from the National Health and Nutrition Examination Survey obtained between 1999 and 2004, focusing on adults with type 2 diabetes mellitus. Serum hs-TnT concentrations were evaluated. DKD was defined as impaired glomerular filtration rate (< 60 mL/minute/1.73 m²), proteinuria (urinary albumin-to-creatinine ratio of ≥ 30 mg/g), or both conditions in patients with diabetes mellitus. Weighted multivariable logistic regression analysis and restricted cubic spline analyses were employed to examine the independent association between hs-TnT and DKD, with the likelihood ratio test being used to evaluate nonlinearity.

Results: The study included 2505 patients with a mean age of 55.02 (standard error: 0.72) years, of whom 44.87% were females. Among the participants, 909 (32.34%) were diagnosed with DKD. Multivariable logistic regression analysis indicated that, compared to the lowest tertile of hs-TnT (< 5.93 ng/L), tertile 2 (5.94-9.79 ng/L) had an odds ratio of 1.25 (95% confidence interval: 0.77-2.02, P = 0.350), while tertile 3 (9.80-21.88 ng/L) had an odds ratio of 2.07 (95% confidence interval: 1.13-3.80, P = 0.022), with a significant trend (P for trend = 0.022). Smoothed curve fitting demonstrated a linear association between hs-TnT levels and DKD in the overall population (P = 0.061 for nonlinearity) and in male (P = 0.136 for nonlinearity) and female (P = 0.067 for nonlinearity) subgroups. Further stratification and sensitivity analyses yielded consistent conclusions.

Conclusion: Our study findings suggest that in individuals with type 2 diabetes, detectable hs-TnT levels below the 99^th percentile are associated with DKD.