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Published on: February 2, 2021
Troponin T clearance via continuous renal replacement therapies in the ICU
Sean Boyd1, Sabina Mason2, Sean Griffin2
1Department of Critical Care, Tallaght University Hospital, Tallaght, Dublin 24, Ireland. seanboyducd@gmail.com.
Insights
Continuous renal replacement therapy (CRRT) modalities showed no significant difference in cardiac troponin T removal. CRRT clearance of troponin T is minimal, unlikely to affect patient monitoring for acute coronary syndrome.
Area of Science:
- Nephrology
- Cardiology
- Intensive Care Medicine
Background:
- Cardiac troponin T (cTnT) is a critical biomarker for acute myocardial infarction.
- Critically ill patients often require continuous renal replacement therapy (CRRT).
- The impact of CRRT on cTnT levels requires clarification.
Purpose of the Study:
- To compare the efficacy of continuous venovenous hemofiltration (CVVH), continuous venovenous hemodialysis (CVVHD), and continuous venovenous hemodiafiltration (CVVHDF) in removing cardiac troponin T.
- To assess the relationship between circulating cTnT levels and CRRT-mediated clearance in critically ill patients.
Main Methods:
- Prospective observational study at a single center.
- Included adult ICU patients with cTnT > 50 ng/L on CRRT.
- Simultaneous sampling of serum and CRRT effluent for cTnT over 72 hours.
Main Results:
- No significant difference in overall estimated cTnT clearance across CRRT modalities (median 2.6 ml/kg/h).
- CVVH showed a statistically higher percentage of cTnT clearance compared to CVVHD and CVVHDF (16% vs. 15% vs. 10%, p=0.002).
Conclusions:
- CRRT modality does not significantly impact overall cTnT clearance.
- The clearance of cTnT by CRRT is generally low across all methods.
- CRRT is unlikely to substantially interfere with the interpretation of cTnT levels in patients with suspected acute coronary syndrome.
Purpose:
The aim of this study was to compare the removal of cardiac troponin T via continuous venovenous haemofiltration (CVVH), continuous venovenous haemodialysis (CVVHD) and continuous venovenous haemodiafiltration (CVVHDF) as a function of circulating blood troponin T levels in critically ill patients.
Methods:
This was a single-centre, prospective observational study conducted at Tallaght University Hospital (Dublin, Ireland). Adult patients admitted to ICU and commenced on continuous renal replacement therapy (CRRT) were included. All patients required a troponin T level > 50 ng/L. All patients were required to have commenced CRRT > 4 h prior to first sample. The aim was to take three serum samples per patient every 24 h, over a total of 72 h, with simultaneous sampling of the waste effluent for troponin T. Our primary outcome measure was estimated troponin T clearance according to CRRT modality.
Results:
We found no significant difference in estimated troponin T clearance according to CRRT modality (overall median troponin T clearance of 2.6 ml/kg/h). As a secondary outcome, it was noted that the percentage of troponin T clearance was statistically significantly higher for CVVH compared to CVVHD and CVVHDF (16% vs. 15% vs. 10%, respectively; p = 0.002).
Conclusions:
No significant difference in estimated troponin T clearance was found according to CRRT modality. Our results show that clearance of troponin T on CRRT is generally small across all modalities and that ongoing treatment with CRRT is unlikely to substantially impact interpretation and tracking of troponin T results in patients with concern for acute coronary syndrome.
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