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Variation of High-Sensitivity Troponin T Results in Patients Undergoing Continuous Renal Replacement Therapy
Vikas Srinivasan Sridhar1, Michael Chen2, Howard Gerson2
1Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada.
Insights
Continuous renal replacement therapy (CRRT) significantly decreases high-sensitivity cardiac troponin T (hs-cTnT) levels within hours. This finding is crucial for interpreting cardiac injury biomarkers in critically ill patients undergoing CRRT.
Area of Science:
- Cardiology
- Nephrology
- Intensive Care Medicine
Background:
- Cardiac troponins (CTns) are key biomarkers for diagnosing myocardial injury.
- Interpreting serial CTns in end-stage renal disease patients is complicated by hemodialysis-induced declines in high-sensitivity cardiac troponin T (hs-cTnT).
- The potential impact of continuous renal replacement therapy (CRRT) on CTn levels requires investigation.
Purpose of the Study:
- To determine the effect of CRRT on hs-cTnT levels in patients without active myocardial injury.
- To assess changes in hs-cTnT over time during CRRT.
Main Methods:
- Prospective, observational study at a single tertiary care hospital.
- Included 10 critically ill patients with acute kidney injury (AKI) undergoing CRRT (excluding cardiac ICU and acute coronary syndrome patients).
- hs-cTnT levels were measured pre-CRRT, within 6 hours of initiation, and every 6 hours thereafter.
Main Results:
- Mean hs-cTnT levels decreased by 42% within 5 to 10 hours after CRRT initiation compared to baseline.
- hs-cTnT levels plateaued during the remainder of CRRT.
- The primary cause of AKI was acute tubular necrosis from septic or hemorrhagic shock.
Conclusions:
- CRRT causes a significant reduction in hs-cTnT levels within 5 to 10 hours.
- Interpretation of hs-cTnT during CRRT must account for the timing of dialysis initiation and sample collection.
- Findings are specific to the hs-cTnT assay and this single-center study.
Background:
Cardiac troponins are the preferred biomarker to diagnose myocardial injury. Complicating the interpretation of serial troponins in patients with end-stage renal disease, it has been shown that the hemodialysis procedure results in a small but significant decline in high-sensitivity cardiac troponins (hs-cTnT). This raises the possibility that continuous renal replacement therapy (CRRT) might similarly alter cardiac troponin levels and affect their interpretation when cardiac ischemia is being considered.
Objective:
We sought to determine the effect of CRRT on hs-cTnT levels over time in a group of patients without active myocardial injury.
Design:
Prospective, observational study.
Setting:
Single tertiary care hospital, Montreal, Quebec.
Patients:
Ten critically ill patients with acute kidney injury (AKI) undergoing CRRT. Cardiac ICU (intensive care unit) patients and acute coronary syndrome patients were excluded from the study. The CRRT prescription was at the discretion of the treating intensivist and relatively high doses were used in this study.
Measurements:
The hs-cTnT levels were drawn pre-CRRT, within 6 hours of initiation, and approximately every 6 hours thereafter along with routine CRRT blood work.
Methods:
Changes in hs-cTnT, creatinine, and albumin levels were recorded over the course of CRRT. Mean change in serum analyte concentration and 95% confidence interval was determined for specified time intervals relative to baseline, with paired t tests used to determine statistical significance.
Results:
Among the 10 patients included in the study, the cause of AKI was primarily acute tubular necrosis from septic shock or hemorrhagic shock. Compared with baseline hs-cTnT levels prior to CRRT initiation, mean hs-cTnT level fell by 42% at 5 to 10 hours post-CRRT initiation, followed by a plateauing of levels for the duration of time on CRRT.
Limitations:
Single-center study only applicable to hs-cTnT assay.
Conclusions:
This study demonstrates a significant decrease in hs-cTnT within 5 to 10 hours of CRRT initiation. This suggests that interpretation of cardiac troponin changes during CRRT must take into consideration the timing of dialysis initiation relative to the time of sample collection.
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