Association between troponin I levels and mortality in stable hemodialysis patients

Farkouh, Michael E.; Robbins, Michael J.; Zafar, M. Urooj; Shimbo, Daichi; Davidson, Karina W.; Puttappa, Rupa; Winston, Jonathan; Halperin, Jonathan L.; Epstein, Edward; Patel, Mayank; Talor, Zvi; Chesebro, James H.

doi:10.1016/s0002-9343(02)01482-1

Cited by 23 publications

(19 citation statements)

References 14 publications

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“…First, raised cTnI, as defined by the reference limit for normal subjects, was associated with an eight-fold greater risk of death. These findings are consistent with previous studies that associate high concentrations of cTnI with a greater risk of mortality and suggest that the relative risk of death varies in accordance with the cut-off point used in each study (1)(2)(3)15,18). Second, the difference in cTnI levels between patients having spent longer and shorter times on dialysis permits consideration of the possibility that haemodialysis itself could induce myocardial ischaemia and a minor degree of troponin I release in patients undergoing haemodialysis treatment.…”

Section: Discussionsupporting

confidence: 92%

“…Some of them have shown greater cTnI levels after dialysis, others before, yet others have not detected significant changes between pre-and post-dialysis values (3,(9)(10)(11). Reasons for this variation might include the type of clearance and the membranes used in the dialysis.…”

Section: Discussionmentioning

confidence: 99%

“…However, in patients receiving maintenance dialysis, the clinical symptoms of cardiac damage are difficult to diagnose and may be misleading. In addition, the traditional cardiac markers, such as creatine kinase (CK), creatine kinase muscle-brain fraction (CK-MB) and myoglobin, have been found to be deceptively high in patients using dialysis (1)(2)(3).…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, although recent studies demonstrate that serum or plasma cTnI is an important predictor of longterm, all-cause mortality and cardiovascular mortality in patients with ESRD, and that high concentrations of cTnI are associated with increased risk of coronary artery disease in this population (1)(2)(3), other studies conclude that cTnI has little predictive value in renal insufficiency and they do not identify it as an independent risk factor (8,9). Owing to the uncertainty about the usefulness of cTnI in ESRD, the aim of present study was to evaluate the behaviour and prognostic value of cTnI in a population of chronic haemodialysis patients.…”

Section: Introductionmentioning

confidence: 99%

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Comportamiento y valor pronóstico de la troponina I cardiaca en suero en pacientes con enfermedad renal final sometidos a hemodiálisis de largo plazo. Analisis de resultados quinquenales

Almonacid-Urrego

Cantillo-Turbay²,

Tuñón

2009

nova

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Los niveles troponina I cardiaca (cTnI) se consideran una importante herramienta de diagnóstico en los eventos coronarios agudos. Sin embargo, hay controversia sobre su sensibilidad, especificidad y valor pronóstico en la hemodiálisis (HD) de los pacientes. El objetivo de este estudio fue explorar el comportamiento y el valor pronóstico de la troponina I cardiaca en pacientes en HD. Se estudiaron treintaicuatro pacientes asintomáticos sometidos a hemodiálisis a largo plazo. Las muestras de sangre fueron tomadas al inicio del estudio (pre-y post-diálisis en suero), después de tres años (pre-diálisis en suero y plasma, con y sin la adición de anticuerpos heterófilos reactivos de bloqueo (HBR) y después de cinco años (suero pre-diálisis). Se midió la troponina I cardiaca cuantitativa con micro-partículas AxSYM cTnI de la enzima inmuno-ensayo de cTnI y la cualitativa con una prueba de un solo paso de inmuno Troponina Hexagon-cromatografía.No fue posible detectar ninguna asociación significativa entre los niveles de cTnI pre-y post-diálisis. La comparación de los resultados de la heparina de suero y plasma no reveló ninguna diferencia estadísticamente significativa entre el nivel de cTnI y los valores promedio para el plasma y suero con y sin la adición de HBR.Las concentraciones cTnI en las muestras sin HBR añadido fueron más bajas que en aquellas con HBR, pero no se observó diferencia estadísticamente significativa entre la media de cTnI y la media de las muestras con y sin adición de HBR. Durante el estudio, el 35,2% de la población murió. Se observó una asociación positiva entre los valores de cTnI en los pacientes que aún viven y en los pacientes que murieron a causa de la miocardiopatía isquémica (p = 0,039). El crudo riesgo de muerte por enfermedad cardiovascular se ha multiplicado por ocho (el intervalo de 95% de confianza estando entre 1,2 y 51,1) en pacientes con una concentración de cTnI superior a 0,04 ng/ml. Los niveles de cTnI pueden reflejar la isquemia miocárdica oculta e identificar los pacientes en hemodiálisis que se enfrentan a un mayor riesgo de muerte.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comportamiento y valor pronóstico de la troponina I cardiaca en suero en pacientes con enfermedad renal final sometidos a hemodiálisis de largo plazo. Analisis de resultados quinquenales

Almonacid-Urrego

Cantillo-Turbay²,

Tuñón

2009

nova

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“…7 However, the interpretation of association between elevated cTnI levels and mortality were unclear from that meta-analysis due to lack of standardization of assays in the literature, although when individually evaluated, studies point out the prognostic value of cTnI in asymptomatic dialysis patients. 10,[39][40][41] The association of elevated cTnT and cTnI levels with coronary artery calcification in asymptomatic dialysis patients may represent this link between troponins and mortality in the vascular frame. 42 We observed a significant positive correlation between the CA-IMT and the cTnI levels within the patient group.…”

Section: Renal Failurementioning

confidence: 99%

Predictive markers of asymptomatic atherosclerosis in end-stage renal disease patients

Mutluay¹,

Konca²,

Erten³

et al. 2010

Renal Failure

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Objective: Uremia is associated with accelerated atherosclerosis and increased cardiovascular mortality in patients with end-stage renal disease (ESRD). Cardiac injury markers, such as myoglobin, creatine kinase-MB (CK-MB), or troponins, frequently used to recognize acute coronary events, may be falsely elevated in this patient group. In this study, our aim was to (i) test serum levels of myoglobin, CK-MB, and troponin I (cTnI) in ESRD patients without coronary artery disease (CAD) and compare the results with healthy controls and (ii) to investigate the association between these markers and carotid artery intima-media thickness (CA-IMT), high-sensitive C-reactive protein (hs-CRP), and serum uric acid (SUA) levels in ESRD patients. Materials and methods: Fifty-two ESRD patients (25 hemodialysis and 27 peritoneal dialysis) and 17 healthy controls were included in the study. Serum levels of myoglobin, CK-MB, and cTnI were measured and ultrasonographic CA-IMT was determined in all participants. SUA and hs-CRP levels were only measured in the ESRD group. Results: Serum myoglobin, CK-MB levels, and the mean CA-IMT were significantly higher in ESRD group (p < 0.01), whereas cTnI levels were not different compared to healthy controls (p = 0.70). There was also a positive correlation between CA-IMT and cTnI levels (p = 0.003, r = 0.35) and CA-IMT and hs-CRP (p = 0.03, r = 0.30) or SUA levels (p = 0.003, r = 0.43). Conclusion: cTnI may serve as a more sensitive marker in detecting cardiovascular events in patients with renal failure. Besides the traditional risk factors of atherosclerosis, cTnI, hs-CRP, and SUA may have a predictive role in recognizing premature atherosclerosis in ESRD patients.

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Determinants and prognostic significance of an intra-dialysis rise of cardiac troponin I measured by sensitive assay in hemodialysis patients

et al. 2013

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Association between troponin I levels and mortality in stable hemodialysis patients

Cited by 23 publications

References 14 publications

Comportamiento y valor pronóstico de la troponina I cardiaca en suero en pacientes con enfermedad renal final sometidos a hemodiálisis de largo plazo. Analisis de resultados quinquenales

Comportamiento y valor pronóstico de la troponina I cardiaca en suero en pacientes con enfermedad renal final sometidos a hemodiálisis de largo plazo. Analisis de resultados quinquenales

Predictive markers of asymptomatic atherosclerosis in end-stage renal disease patients

Determinants and prognostic significance of an intra-dialysis rise of cardiac troponin I measured by sensitive assay in hemodialysis patients

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