Abstract
BackgroundIn end-stage renal disease (ESRD), troponin T concentrations can be elevated even without cardiac ischaemia, which hampers the diagnosis of acute myocardial infarction (AMI). The objectives of our study were to determine the proportion of dialysisdependent ESRD patients without acute coronary syndrome (ACS) but with highly sensitive cardiac troponin T (hs-cTnT) levels above the 99th percentile upper reference limit and to evaluate the range of hs-cTnT among this population.MethodsA cross-sectional study was conducted at the haemodialysis (HD) unit of a tertiary hospital in Malaysia from January 2018 to February 2019. Dialysis-dependent ESRD patients were included and those with a recent history of ACS (within 30 days) were excluded. Pre-dialysed serum hs-cTnT levels were measured using Cobas e411. The upper limit of the 99th percentile value for troponin T was 14 ng/L.ResultsA total of 150 patients were recruited as study participants. The majority were female (62%) and of Malay ethnicity (94%), and the mean (SD) age was 45.19 (16.36) years old. The hs-cTnT range (min, max) was 11.39–738.30 ng/L and the median (interquartile range [IQR]) of hs-cTnT was 59.20 (83.41) ng/L. Elevated hs-cTnT levels were observed in 149/150 (99%) of the study participants (54/55 [98.2%] of the patients were on HD, and 95/95 [100.0%] of the patients were on continuous ambulatory peritoneal dialysis).ConclusionThis study supports prior research showing that even without ACS, most ESRD patients have elevated concentrations of cardiac troponin. Furthermore, our study illustrates the need to revisit the use of absolute troponin values when making a diagnosis of ACS in ESRD patients.
Highlights
For the past 30 years, cardiac troponin levels have been used as the diagnostic biochemical marker for pathologies associated with cardiomyocyte death, myocardial infarction [1]
Cardiac troponin T is a low molecular weight protein weighing 37 kDa [4] and is encoded by different genes to those of skeletal muscle troponin [1]. cTnT is expressed in cardiomyocytes; it is structurally specific to the myocardium compared to creatine kinase or creatine kinase-MB [1, 5]
The eligibility criteria were all in-centre end-stage renal disease (ESRD) patients, defined as those having a glomerular filtration rate (GFR) of less than 15 mL/min/1.73 m2 based on the Modification of Diet in Renal Disease GFR equation, patients aged 18 years old and above, patients on haemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) and patients without acute coronary syndrome (ACS) or ECG changes suggestive of MI during the 30-day period prior to recruitment
Summary
For the past 30 years, cardiac troponin (cTn) levels have been used as the diagnostic biochemical marker for pathologies associated with cardiomyocyte death, myocardial infarction [1]. Serial measurements of cTn values as well as other elements of the clinical evaluation are needed to establish a diagnosis of acute myocardial infarction (AMI) [2–3]. Troponins are regulatory protein complexes located on the thin filaments of striated muscles and consist of three different subunits: troponin C, troponin I and troponin T. They control the interaction of calcium-mediated actin and myosin for muscle contraction [1]. In end-stage renal disease (ESRD), troponin T concentrations can be elevated even without cardiac ischaemia, which hampers the diagnosis of acute myocardial infarction (AMI). The objectives of our study were to determine the proportion of dialysisdependent ESRD patients without acute coronary syndrome (ACS) but with highly sensitive cardiac troponin T (hs-cTnT) levels above the 99th percentile upper reference limit and to evaluate the range of hs-cTnT among this population
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