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[Cardiovascular risk markers in hemodialysis]
Summary
Dialysis adequacy may improve cardiovascular outcomes by reducing homocysteine levels, with on-line hemodiafiltration being most effective. Cardiac markers like troponin I and CK-MB mass remain stable during dialysis, aiding diagnosis in hemodialysis patients.
Area of Science:
- Nephrology
- Cardiology
- Biochemistry
Context:
- Cardiovascular disease is a leading cause of mortality in hemodialysis patients.
- Accurate diagnosis of myocardial infarction is challenging due to elevated cardiac markers in uremic patients.
- Homocysteine is an additional cardiovascular risk factor in uremic patients.
Purpose:
- To evaluate the influence of dialysis on serum troponin I and CK-MB mass.
- To assess serum homocysteine (Hcy) levels as a cardiovascular risk factor in uremic patients.
- To determine if dialysis adequacy impacts cardiovascular outcomes.
Summary:
- Standard hemodialysis (HD) and on-line hemodiafiltration (HDF) did not significantly alter serum troponin I and CK-MB mass.
- On-line HDF demonstrated a reduction in homocysteine levels, correlating with dialysis adequacy (Kt/V and URR%).
- Post-dialysis troponin I and CK-MB mass showed correlations with electrolytes (sodium, potassium, chlorine) in standard HD.
Impact:
- Troponin I and CK-MB mass can be reliably used for diagnosing cardiac ischemia in hemodialysis patients as they are not affected by the dialysis procedure.
- Convective treatments like on-line HDF appear superior in reducing homocysteine levels, potentially improving cardiovascular outcomes.
- Identifying high-risk patients and offering on-line HDF may be a suitable therapeutic strategy.