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Published on: October 2, 2020
The effect of hemodialysis on cardiac enzyme levels and echocardiographic parameters
Muharrem Ingec1, Ebru Gok Oguz, Tolga Yildirim
11 Department of Nephrology, School of Medicine, Harran University, Sanliurfa - Turkey.
Insights
Hemodialysis significantly increases cardiac troponin I (cTnI) levels, a marker of myocardial damage, in patients undergoing treatment. Further research is needed to understand the clinical implications of these elevated cTnI levels.
Area of Science:
- Cardiology
- Nephrology
- Biochemistry
Background:
- Cardiac troponins (cTnI) are sensitive indicators of myocardial injury.
- Elevated troponin levels can occur in hemodialysis patients without active cardiac disease.
- The impact of hemodialysis on cardiac enzyme levels and echocardiographic parameters requires investigation.
Purpose of the Study:
- To evaluate the effect of a single hemodialysis session on echocardiographic parameters.
- To assess changes in cardiac enzyme levels, including cTnI, CPK, and CK-MB, post-hemodialysis.
Main Methods:
- Prospective study of 40 chronic hemodialysis patients.
- Echocardiography performed before and after hemodialysis.
- Measurement of cTnI, CPK, and CK-MB levels pre- and post-hemodialysis.
Main Results:
- Post-dialysis cTnI levels were significantly higher than pre-dialysis levels (p=0.03).
- Significant changes observed in left ventricular dimensions, ejection fraction, left and right atrial diameters, pulmonary artery pressure, and right ventricular end-diastolic diameter.
- No significant increase in CPK or CK-MB levels; no correlation found between echocardiographic changes and ultrafiltration, blood flow, age, or gender.
Conclusions:
- Hemodialysis treatment is associated with an increase in cTnI levels.
- The clinical significance of elevated cTnI in hemodialysis patients, particularly those with coronary artery disease, remains undetermined.
- Large-scale, multi-center studies are necessary to clarify the prognostic impact of these findings.
Background:
Cardiac troponins are specific and sensitive markers of myocardial damage. Troponin levels may increase without an obvious active cardiac disease in hemodialysis patients. In this study, we aimed to investigate the effect of a single hemodialysis session on echocardiographic parameters and cardiac enzyme levels, including cTn-I, creatine phosphokinase (CPK), and creatine kinase-MB (CK-MB).
Patients And Methods:
Forty patients under chronic hemodialysis treatment enrolled in this prospective study. All the patients had a physical examination and underwent echocardiography before and after hemodialysis. cTn-I, CPK and CK-MB levels were also determined before and after hemodialysis in all patients.
Results:
Post-dialysis cTn-I levels were significantly higher compared to pre-dialysis levels (p = 0.03). cTn-I levels increased in 26 patients, did not change in 1 patient and decreased in 13 patients after hemodialysis when compared to the values determined before hemodialysis. There was no significant increase in CPK and CK-MB levels after dialysis. Statistically significant changes were detected in the end-systolic diameter of the left ventricle, end-diastolic diameter of left ventricle, ejection fraction, diameter of the left atrium, diameter of the right atrium, pulmonary artery pressure and end-diastolic diameter of the right ventricle. However, there was no significant relation between these echocardiographic changes and ultrafiltration volume, blood flow rate, age, and gender.
Conclusions:
Hemodialysis leads to an increase in cTnI levels. However, the effect of increased cTnI levels on survival rates in hemodialysis patients with underlying coronary artery disease has not yet been determined. Prospective multi-center studies with large sample size are required to clarify this issue.
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