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High sensitivity Troponin-I levels in asymptomatic hemodialysis patients

Tanawat Tarapan1, Khrongwong Musikatavorn1,2, Piyarat Phairatwet3

  • 1a Emergency Medicine Unit, Outpatient Department , King Chulalongkorn Memorial Hospital, The Thai Red Cross Society , Bangkok , Thailand.

Renal Failure
|May 29, 2019
PubMed

Insights

High-sensitivity troponin I (hsTnI) levels are elevated in hemodialysis (HD) patients, complicating acute myocardial infarction (AMI) diagnosis. Dynamic hsTnI monitoring is crucial, as HD may induce silent myocardial injury.

Area of Science:

  • Cardiology
  • Nephrology
  • Biomarkers

Background:

  • Renal clearance reduction and hemodialysis (HD) impact high-sensitivity troponin I (hsTnI) levels, affecting acute myocardial infarction (AMI) diagnosis in chronic kidney disease (CKD) patients.
  • The HD procedure itself may induce myocardial injury, further altering hsTnI levels.

Purpose of the Study:

  • To compare hsTnI levels between asymptomatic HD patients and a non-CKD population.
  • To evaluate the dynamic changes in hsTnI levels before and after HD.
  • To identify potential risk factors for HD-induced myocardial injury.

Main Methods:

  • A comparative cross-sectional study involving 100 asymptomatic HD patients and 107 matched non-CKD individuals.
  • Measurement of hsTnI levels pre- and post-HD in the patient cohort.
  • Statistical analysis to compare hsTnI levels and identify risk factors.

Main Results:

  • Asymptomatic HD patients exhibited significantly higher baseline hsTnI levels compared to the non-CKD group (median [IQR]: 54.3 [20.6-152.7] vs. 18 [6.2-66.1] ng/L).
  • hsTnI levels decreased post-HD (median [IQR]: 54.3 [20.6-152.7] ng/L pre-HD to 27.1 [12.3-91.4] ng/L post-HD).
  • Approximately 25% of HD patients showed increased hsTnI post-HD, suggesting potential HD-induced myocardial injury, associated with high hemoglobin and blood flow rate.

Conclusions:

  • Baseline hsTnI levels are elevated in asymptomatic HD patients, necessitating careful interpretation for AMI diagnosis.
  • Monitoring dynamic hsTnI changes during HD is essential for accurate AMI assessment.
  • HD-induced silent myocardial injury occurs in a subset of patients, highlighting the need for proactive cardiovascular risk management.

Keywords:
HemodialysisTroponin Imyocardial injury

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