A comparison of markers of myocardial injury and their relation to nutritional parameters in hemodialysis patients

Abstract

Background: Serum cardiac troponin T (cTnT) is a valuable marker of ischemic heart disease (IHD) and left ventricular hypertrophy, as well as a mortality predictor in hemodialysis populations. We compared the value of cTnT, creatinine kinase (CK)-MB mass and myoglobin as mortality predictors in our hemodialysis patients and evaluated their relation to nutritional status. Methods: A total of 118 hemodialysis patients were prospectively studied from January 2004 to April 2013. Clinical and laboratory evaluations during the 12-month baseline period included the history of IHD, signs of left ventricular hypertrophy (LVH), Kt/V and serum cardiac markers together with the percentage of body fat (%fat), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), triceps skinfold (TSF) and BMI. Results: Underweight patients had significantly higher cTnT values (Mann–Whitney, p < 0.05). Correlation analysis (Spearman) showed an inverse association between cTnT and TSF (ρ = −0.22, p < 0.05), as well as between CK-MB mass and TSF (ρ = −0.26, p < 0.01). In men cTnT also correlated inversely with %fat (ρ = −0.27, p < 0.05) and BMI (ρ = −0.33, p < 0.05). In addition, myoglobin was correlated significantly with MAC, MAMC and albumin. Among cardiac markers cTnT was the only independent variable predicting mortality (Multivariate Cox regression, HR = 1.04 CI (1.01–1.07); p < 0.01; measurement units 0.01 μg/L). Conclusion: Troponin T and CK-MB mass were significantly elevated in the underweight patient group. Troponin T was the only independent cardiac marker predictor of all cause mortality in our hemodialysis patients.