The Intradialytic Changes in Cardiac Troponin I-A Systematic Review

Cardiovascular disease is the leading cause of death in patients receiving hemodialysis. Current guidelines define acute myocardial infarction (AMI) by troponin levels above the 99th percentile, accompanied by a ≥ 20% rise or fall. However, troponin concentrations are often elevated, and hemodialysis may influence troponin levels during treatment. This systematic review aims to evaluate whether these factors compromise the diagnostic accuracy of troponin for AMI in patients undergoing hemodialysis. We performed a systematic review including 6359 studies. Inclusion criteria were adult patients and studies reporting predialysis and postdialysis assessment of troponin I. Twenty-eight studies were deemed suitable. Mean troponin I was assessed before and after dialysis. The risk of bias and applicability of the included studies were assessed. The studies were heterogeneous in terms of reporting intradialytic changes of troponin, either in mean or median, which was a problem, along with the lack of reporting dialysis details. The mean troponin predialysis was 68 ng/L, and the mean troponin postdialysis was 73 ng/L. The troponin changes during dialysis were between -100% and +933%. The per se elevated troponin I and the unpredictable changes during dialysis make the use of the current AMI guidelines challenging for patients on dialysis.