High sensitivity Troponin-I levels in asymptomatic hemodialysis patients

Abstract

Reduction in renal clearance and removal by hemodialysis adversely affect the level and utility of high-sensitivity troponin I (hsTnI) for diagnosis of acute myocardial infarction (AMI) in hemodialysis (HD) patients. Furthermore, HD process itself might cause undesirable myocardial injury and enhance post HD hsTnI levels. This comparative cross-sectional study was conducted to compare the hsTnI levels between 100 asymptomatic HD patients and their 107 matched non-chronic kidney disease (CKD) population. The hsTnI levels in HD group were higher than non-CKD group [median (IQR): 54.3 (20.6–152.7) vs. 18 (6.2–66.1) ng/L, p < .001)]. The hsTnI levels reduced after HD process from 54.3 (20.6–152.7) ng/L in pre-HD to 27.1 (12.3–91.4) ng/L in post-HD ( p = .015). Of interest, 25% of HD patients had increment of hsTnI after HD and might represent HD-induced myocardial injury. The significant risk factors were high hemoglobin level and high blood flow rate. In conclusion, the baseline hsTnI levels in asymptomatic HD patients were higher than non-CKD population. The dynamic change of hsTnI over time would be essential for the diagnosis of AMI. Certain numbers of asymptomatic HD patients had HD-induced silent myocardial injury and should be aggressively investigated to prevent further cardiovascular mortality.

Value of the high-sensitivity troponin T assay for diagnosis of acute myocardial infarction in patients with and without renal insufficiency

“…One study showed that the normal range of serum hs-cTnT in patients with CKD is higher than that in patients without CKD (139 ng/L in patients with CKD versus 14 ng/L in patients without CKD) [23]. Another study revealed that the baseline hs-cTnT levels in asymptomatic hemodialysis patients were higher than non-CKD patients (54.3 versus 18 ng/L) [24]. Receiver operating characteristic curves of high-sensitivity cardiac troponin-T (TnT) levels on admission, and dynamic changes in these levels for the diagnosis of acute myocardial infarction (diagnosis based on coronary angiography or cardiac echocardiography) (A) for patients with eGFR < 60 mL/min/1.73 m 2 , (B) patients with eGFR > 60 mL/min/1.73 m 2 , (C) patients with chronic kidney disease (CKD) history, and (D) patients without CKD history.…”

“…One study showed that the normal range of serum hs-cTnT in patients with CKD is higher than that in patients without CKD (139 ng/L in patients with CKD versus 14 ng/L in patients without CKD) [ 23 ]. Another study revealed that the baseline hs-cTnT levels in asymptomatic hemodialysis patients were higher than non-CKD patients (54.3 versus 18 ng/L) [ 24 ]. Nevertheless, the Fourth Universal Definition of myocardial infarction used the same value of hs-cTnT for the diagnosis of AMI in patients either with reduced or normal eGFR.…”

High-sensitivity troponin in chronic kidney disease: Considerations in myocardial infarction and beyond

“…Since the introduction of 5 th generation hs-cTn, non-ischaemic troponin elevation above the reference threshold, now termed 'myocardial injury', is commonly seen in patients with CKD; affecting up to 75% of dialysis patient (Gunsolus et al, 2018;Miller-Hodges et al, 2018;Sandoval et al, 2017;Sarkisian et al, 2016;Shah et al, 2018;Tarapan et al, 2019). Numerous studies have suggested that myocardial injury is now the most common cause of troponin elevation and confers a poor prognosis independent of the underlying mechanism of its elevation (Chew et al, 2014;McFalls et al, 2011;Miller-Hodges et al, 2018;Tarapan et al, 2019).…”

Correct anemia or prevent acute myocardial infarction in patients on maintenance hemodialysis?

“…Tarapan et al. [1] research results are very meaningful. The association between Hb and hsTnI in MHD patients is complicated and urgently needs more studies to confirm.…”

“…After careful reading through the article called ‘High sensitivity Troponin-I levels in asymptomatic hemodialysis patients’ by Tarapan et al. [1]. Cardiac troponin-I is a well-known crucial parameter in diagnosis of acute myocardial infarction (AMI).…”