OBJECTIVE Both serum cardiac troponin T (cTnT) and renal function are prognostic predictors in patients with chronic heart failure (CHF). We aimed to evaluate the relationship between renal function and serum cTnT. RESULTS We measured serum concentrations of cTnT in the aortic root (AO) and coronary sinus (CS) in 258 CHF patients. Patients were divided into two groups: patients with an estimated glomerular filtration rate (eGFR) >or= 60 mL/min/1.73 m(2) [chronic kidney disease (CKD)(-)], and patients with an eGFR < 60 mL/min/1.73 m(2) [CKD (+)]. In 32 (12%) of the 258 CHF patients, serum levels of cTnT were detectable (>or=0.03 ng/mL) in the AO and in the CS. There was no correlation between eGFR and the transcardiac increase in cTnT and there was a significant negative correlation between eGFR and the serum cTnT concentration (r = - 0.365, P = 0.039). There was no difference in the transcardiac gradient of cTnT between patients without CKD (n = 16) and patients with CKD (n = 16) (0.083 +/- 0.11 vs. 0.108 +/- 0.13 ng/mL, P = 0.55). However, the serum cTnT level in the AO was two-fold higher in CHF patients with CKD than patients without CKD (0.20 +/- 0.177 vs. 0.088 +/- 0.065 ng/mL, P < 0.05). CONCLUSIONS These findings indicate that decreased clearance via the kidney contributes to the elevated cTnT in CHF patients with CKD.