Constant Fluid Removal Associates With Greater Risk of Elevated High-Sensitivity Troponin I Than Downward Sloping...

High ultrafiltration rate is a common clinical problem in those undergoing maintenance dialysis and is associated with myocardial injury and increased mortality. The safety of the downward sloping profile of ultrafiltration in those with high ultrafiltration rates is currently unknown. The aim of the present study is to compare mean arterial pressure trends and dialysis-associated high-sensitivity Troponin I changes among patients with high ultrafiltration rates undergoing constant and profiled ultrafiltration.

The enrolled study participants were patients on maintenance dialysis thrice weekly with ultrafiltration rates > 13 mL/kg/h and without known cardiac disease. During the study month, they received six sessions with constant ultrafiltration and six sessions with downward sloping profiled ultrafiltration. Pre-to-post HD hs TnI change, blood pressures, and intradialytic hypotension episodes were measured during all 12 sessions.

A total of 42 study participants with 504 dialysis sessions were analyzed. The mean age of study participants was 41.3 (±12.1) years, two-thirds were male, and up to 17% had diabetes mellitus. The mean ultrafiltration volume was 17.4 (±3.2) mL/kg/h. Mean arterial pressures and intradialytic hypotension did not differ significantly between constant and profiled sessions, except for trends toward higher pressures at the post-HD timepoint in profiled UF (p = 0.08). Upon comparing Δ Post-Pre-HD hs Tn I of constant versus profiled ultrafiltration, constant sessions showed a median rise of troponin, ranging from 8 to 21 ng/mL from pre- to post-HD, and profiled sessions showed a median fall, ranging from 11 to 21 ng/mL from pre- to post-HD during profiled UF sessions (p < 0.001). Multivariate logistic regression analysis showed that constant UF type was associated with 27 times greater odds of developing a 10% rise in high-sensitivity troponin.

In maintenance dialysis patients with high ultrafiltration, constant fluid removal is associated with a rise in hs Tn I, and a downward sloping profile may be safer than constant fluid removal.

Clinical Trials Registry of India (CTRI): CTRI/2023/02/049618.