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Cardiac troponin T in hemodialyzed patients
1Department of Laboratory Medicine, Ottawa Civic Hospital, Ontario, Canada. dsooi@civich.ottawa.on.ca
Insights
Elevated cardiac troponin T (cTnT) is common in hemodialysis patients, often increasing post-dialysis. Diabetic complications significantly correlate with higher cTnT levels in this population.
Area of Science:
- Nephrology
- Cardiology
- Clinical Chemistry
Background:
- Elevated cardiac troponin T (cTnT) is a marker for cardiac injury.
- Hemodialysis patients often present with comorbidities that can affect cTnT levels.
Purpose of the Study:
- To investigate the prevalence and patterns of elevated cTnT in hemodialysis patients.
- To explore potential correlations between cTnT levels and factors like dialysis parameters and diabetic complications.
Main Methods:
- Prospective study of 174 hemodialysis patients.
- Measurement of cardiac troponin T (cTnT) concentrations.
- Analysis of cTnT levels in relation to dialysis, comorbidities, and specific diabetic complications.
Main Results:
- 29% of patients had cTnT >0.10 microg/L, 10% had cTnT >0.20 microg/L.
- cTnT increased post-dialysis in 10/12 patients.
- 60% of diabetic patients showed elevated cTnT, with higher levels in those with multiple complications.
- Elevated cTnT was observed in 70-100% of patients with specific diabetic vascular complications.
Conclusions:
- Increased cTnT concentrations are frequent in hemodialysis patients.
- Diabetic complications, particularly microvascular and macrovascular diseases, are strongly associated with elevated cTnT.
- Routine dialysis parameters do not fully explain elevated cTnT levels.
Abstract:
We studied the extent and pattern of increased cardiac troponin T (cTnT) concentrations in 174 hemodialyzed patients. cTnT concentrations were above 0.10 and 0.20 microg/L in 29% and 10% of patients, respectively. In patients without acute coronary disease, the highest value observed was 3.2 microg/L. cTnT increased after dialysis in 10 of 12 patients, with a mean increase of 0.14 microg/L. In 125 patients with samples taken at 1-month intervals, 34% of patients showed differences <20%, but 16% of patients had differences greater than twofold. Serum creatinine and urea, adequacy of dialysis, and duration on dialysis did not explain increased concentrations. Sixty percent of 57 diabetic patients had increased concentrations; the patients with multiple diabetic complications had the highest positivity. cTnT was increased in all eight patients with complications of neuropathy, retinopathy, coronary, and peripheral vascular disease; in 80% of patients with neuropathy; in 77% with peripheral vascular disease; in 73% with retinopathy; and in 70% with coronary artery disease.