Background: In end-stage renal disease (ESRD), cardiac troponin T (cTnT) elevation predicts cardiovascular mortality but underling mechanism is not clear. The aim of this study is to assess the relationship between inflammation and malnutrition with cTnT elevation in ESRD without acute coronary syndrome. Methods: We included 204 patients on maintenance hemodialysis (102 men). The nutritional status was assessed with anthropometric measurements and subjective global assessment (SGA). Inflammatory status was assessed using highly sensitive CRP (hsCRP) as positive acute phase reactant and hepatic protein (albumin and prealbumin) as negative acute phase reactant. Subjects were divided into four groups according to their hsCRP (high hsCRP if hsCRP  5 mg/L) and albumin values (hypoalbuminemia if albumin <3.8g/L); group 1: low hsCRP without hypoalbuminemia, group 2: low hsCRP with hypoalbuminemia, group 3: high hsCRP without hypoalbuminemia, and group 4: high hsCRP with hypoalbuminemia. Results: Comparison among groups is detailed in Table. Only the presence of high hsCRP with hypoalbuminemia was independent correlate of cTnT  0.1g/L(p=0.023) in a multiple logistic regression model including age, sex, hypertension, smoking, diabetes, hsCRP, albumin, nutritional parameters, and the presence of high hsCRP with hypoalbuminemia. Conclusion: Severe inflammation, rather than inflammation combined with malnutrition, evidenced by high hsCRP and low hepatic proteins, is associated with cTnT elevation. Inflammation may be the principal cause of a myocardial damage associated with cardiovascular mortality in ESRD.