Luo XY, Huang LH, Kang KP. Association between high-sensitivity troponin T levels below the ninety-ninth percentile and diabetic kidney disease: A cross-sectional study. World J Diabetes 2025; 16(3): 99108 [DOI: 10.4239/wjd.v16.i3.99108]
Corresponding Author of This Article
Kun-Peng Kang, MD, Department of Cardiovascular Medicine, The First Affiliated Hospital of Gannan Medical University, No. 128 Jinling West Road, Ganzhou Economic and Technological Development Zone, Ganzhou 341000, Jiangxi Province, China. gydkangkunpeng@163.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. Mar 15, 2025; 16(3): 99108 Published online Mar 15, 2025. doi: 10.4239/wjd.v16.i3.99108
Association between high-sensitivity troponin T levels below the ninety-ninth percentile and diabetic kidney disease: A cross-sectional study
Xiao-Yan Luo, Li-Hua Huang, Kun-Peng Kang
Xiao-Yan Luo, Department of Interventional Radiology, The Second Affiliated Hospital of Gannan Medical University, Ganzhou 341600, Jiangxi Province, China
Li-Hua Huang, Department of Clinical Laboratory, The Second Affiliated Hospital of Gannan Medical University, Ganzhou 341600, Jiangxi Province, China
Kun-Peng Kang, Department of Cardiovascular Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China
Co-first authors: Xiao-Yan Luo and Li-Hua Huang.
Author contributions: Luo XY and Huang LH designed the study, developed the methodology, and participated in formal analysis and investigation, and they contributed equally to this article as co-first authors; Luo XY drafted the original manuscript; Huang LH and Kang KP contributed to the review and editing process; and all authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the Second Affiliated Hospital of Gannan Medical University (approval No. EFYJ20240113007).
Informed consent statement: Both the National Health and Nutrition Examination Survey protocol and the measurement of high-sensitivity troponin T in stored samples were approved by the Ethics Review Board of the National Center for Health Statistics. Written informed consent was obtained from all participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Publicly accessible datasets pertinent to this study are accessible online. The nomenclature of the repository/repositories can be found at the following web address: http: //www.cdc.gov/nchs/nhanes.htm.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kun-Peng Kang, MD, Department of Cardiovascular Medicine, The First Affiliated Hospital of Gannan Medical University, No. 128 Jinling West Road, Ganzhou Economic and Technological Development Zone, Ganzhou 341000, Jiangxi Province, China. gydkangkunpeng@163.com
Received: July 14, 2024 Revised: December 13, 2024 Accepted: January 6, 2025 Published online: March 15, 2025 Processing time: 191 Days and 5.8 Hours
Abstract
BACKGROUND
Identification of myocardial injury has traditionally relied on high-sensitivity troponin T (hs-TnT) levels exceeding the 99th 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 99th 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 99th percentile are associated with DKD.
Core Tip: High-sensitivity troponin T levels below the 99th percentile show a significant linear association with diabetic kidney disease in type 2 diabetes mellitus patients. This association, derived from National Health and Nutrition Examination Survey data analysis, suggests that even subclinical elevations in high-sensitivity troponin T could serve as an early indicator for diabetic kidney disease risk assessment, particularly in the highest tertile (9.80-21.88 ng/L) with an odds ratio of 2.07.
