Effect of hemodialysis on traditional and innovative cardiac markers

Area of Science:

• Cardiology
• Nephrology
• Clinical Biochemistry

Background:

• Diagnosing acute coronary syndrome (ACS) in patients with impaired renal function presents challenges due to elevated serum biomarkers.
• Standard ACS diagnostic biomarkers like cardiac troponin T (cTnT), creatine kinase isoenzyme MB (CK-MB), myoglobin, and ischemia modified albumin (IMA) are frequently increased in patients undergoing chronic hemodialysis (HD).

Purpose of the Study:

• To evaluate the diagnostic utility of serum biomarkers for ACS in patients with impaired renal function undergoing chronic HD.
• To assess the impact of hemodialysis on the levels of cTnT, CK-MB, myoglobin, and IMA.
• To determine the reliability of these biomarkers for ACS diagnosis and long-term risk stratification in HD patients.

Main Methods:

• Assay of serum IMA, cTnT, CK-MB, and myoglobin in 45 patients prehemodialysis (pre-HD) and posthemodialysis (post-HD).
• Results were adjusted for hemoconcentration.
• Analysis of biomarker values against established diagnostic thresholds for ACS.

Main Results:

• Pre-HD, serum IMA and cTnT were elevated above diagnostic thresholds in 13% and 60% of HD patients, respectively.
• Post-HD, a significant increase in serum IMA was observed (+38%), while cTnT, CK-MB, and myoglobin levels significantly decreased.
• These findings highlight the dynamic changes in biomarker concentrations during hemodialysis.

Conclusions:

• Biomarkers of myocardial injury, particularly cTnT and IMA, can be utilized in HD patients for ACS diagnosis, but require careful interpretation based on individual baseline values, metabolism, and sampling time.
• IMA may be useful for long-term risk stratification in HD patients but is not recommended for diagnosing ACS during or immediately after HD.
• Appropriate diagnostic interpretation strategies are crucial for accurate ACS assessment in this patient population.