The variation in high sensitive cardiac troponin concentration during haemodialysis treatment is not similar to the biological variation observed in stable end stage renal disease patients

Skadberg, Øyvind; Sandberg, Sverre; Røraas, Thomas; Petersen, Per Hyltoft; Sellevoll, Hilde; Svarstad, Einar; Sæle, Kristin; Aakre, Kristin Moberg

doi:10.1080/00365513.2016.1230886

Cited by 10 publications

(15 citation statements)

References 41 publications

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“…The median pre-dialysis hsTnI levels in asymptomatic HD patients reported in previous studies were 13–25 ng/L (Table 3)[14,16,17,19]. The present study had the median pre-dialysis hsTnI levels of 54.3 ng/L (20.6–152.7).…”

Section: Discussionsupporting

confidence: 46%

“…The effect of HD on hsTnI levels are unestablished, reporting either increasing [17], unchanged [14,18] or decreasing of post-dialysis hsTnI levels (Table 3) [19,24]. The present study demonstrated that dialysis process affected the levels of hsTnI.…”

Section: Discussionmentioning

confidence: 56%

“…This might not represent the majority of HD patients currently undergoing high-flux HD which includes either HD or online hemodiafiltration (HDF) using high-flux dialyzer. Three studies in high-flux HD patients included quite a small number of patients [14,18,19] while the other two studies did not focus on the subgroup of patients with heightened post-dialysis hsTnI from possible intradialytic myocardial hypoperfusion [15,16]. On the contrary, modern HD modalities might remove TnI molecule and reduce post-dialysis hsTnI levels.…”

Section: Introductionmentioning

confidence: 99%

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High sensitivity Troponin-I levels in asymptomatic hemodialysis patients

et al. 2019

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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.

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Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

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High sensitivity Troponin-I levels in asymptomatic hemodialysis patients

et al. 2019

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“…Current understanding of cTn variability is insufficient in these cohorts, as relatively few studies have been performed in individuals with renal or cardiac disease, as summarised in Table 2 and Table 3 respectively. 36,37,[71][72][73]75,[81][82][83][84][85] Interestingly, the biological variability of cTn has been found to be fairly similar between healthy individuals and individuals requiring dialysis. 36,71,73 Furthermore, the biological variability of cTn in individuals with stable coronary artery disease or cardiac failure has also been found to be comparable to that in healthy individuals.…”

Section: Biological Variation Results From Previous Studiesmentioning

confidence: 99%

Revisiting the Biological Variability of Cardiac Troponin: Implications for Clinical Practice

Lan

Bell

2019

CBR

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The diagnosis of acute myocardial injury requires a rise and/or fall of cardiac troponin (cTn) on serial testing, with at least one concentration above the 99th percentile value of a normal reference population according to the recently published Fourth Universal Definition of Myocardial Infarction.1 However, the magnitude of change in cTn that constitutes a significant rise and/or fall was again not specified in detail. High-sensitivity cardiac troponin (hs-cTn) assays can measure ten-fold lower concentrations of cTn with more precision than older assays, and can accurately quantitate cTn in more than 50% of healthy individuals with a coefficient of variation of less than 10% at the 99th percentile. These hs-cTn assays are also able to detect the normal variations in cTn results that are due to biological variability. Understanding and quantifying the normal variations in cTn is important as this would allow significant changes to be better defined. Numerous studies have sought to investigate the biological variability of cTn over the last ten years. Such studies are usually conducted in healthy individuals, however individuals with chronic cardiac disease or chronic renal failure have also been examined. These studies have yielded varying results in regards to significant change values for cTn. In light of the recent redefinition for myocardial infarction, the purpose of this mini-review is to revisit the biological variability of cTn. In particular, we outline concepts for determining a significant change value, review the results of previous studies on the biological variation of cTn and discuss potential considerations for clinical practice.

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“…The results revealed a need to identify optimal cut-off points of troponins for patients with CKD and ACS for proper risk stratification. Aligned with these conclusions is the study performed by Skadberg et al [21]. The author measured, using hs-Tn assays, troponin levels before and after hemodialysis and found that mean values decreased during this process.…”

Section: Chronic Kidney Diseasementioning

confidence: 85%

Benefits of Home-Based Solutions for Diagnosis and Treatment of Acute Coronary Syndromes on Health Care Costs: A Systematic Review

Redon

Shahzad

Iqbal

et al. 2020

Sensors

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Diagnosing and treating acute coronary syndromes consumes a significant fraction of the healthcare budget worldwide. The pressure on resources is expected to increase with the continuing rise of cardiovascular disease, other chronic diseases and extended life expectancy, while expenditure is constrained. The objective of this review is to assess if home-based solutions for measuring chemical cardiac biomarkers can mitigate or reduce the continued rise in the costs of ACS treatment. A systematic review was performed considering published literature in several relevant public databases (i.e., PUBMED, Cochrane, Embase and Scopus) focusing on current biomarker practices in high-risk patients, their cost-effectiveness and the clinical evidence and feasibility of implementation. Out of 26,000 references screened, 86 met the inclusion criteria after independent full-text review. Current clinical evidence highlights that home-based solutions implemented in primary and secondary prevention reduce health care costs by earlier diagnosis, improved patient outcomes and quality of life, as well as by avoidance of unnecessary use of resources. Economical evidence suggests their potential to reduce health care costs if the incremental cost-effectiveness ratio or the willingness-to-pay does not surpass £20,000/QALY or €50,000 limit per 20,000 patients, respectively. The cost-effectiveness of these solutions increases when applied to high-risk patients.

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The variation in high sensitive cardiac troponin concentration during haemodialysis treatment is not similar to the biological variation observed in stable end stage renal disease patients

Abstract: The CV and CV are similar to earlier findings. Mean hs-cTn concentrations decreased during HD. The within-subject hs-cTn variation during HD is similar to the between-subject variation, i.e. determining a cut-off value for hs-cTn changes during HD may be useful.

Cited by 10 publications

References 41 publications

High sensitivity Troponin-I levels in asymptomatic hemodialysis patients

High sensitivity Troponin-I levels in asymptomatic hemodialysis patients

Revisiting the Biological Variability of Cardiac Troponin: Implications for Clinical Practice

Benefits of Home-Based Solutions for Diagnosis and Treatment of Acute Coronary Syndromes on Health Care Costs: A Systematic Review

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