Abstract
BackgroundIn hemodialysis patients, elevated plasma troponin concentrations are a common finding that has even increased with the advent of newly developed sensitive assays. However, the interpretation and relevance of this is still under debate.MethodsIn this cross-sectional study, we analyzed plasma concentrations of sensitive troponin I (TnI) and troponin T (TnT) in stable ambulatory hemodialysis patients (n = 239) and investigated their associations with clinical factors and mortality.ResultsIn all of the enrolled patients, plasma TnI or TnT was detectable at a median concentration of 14 pg/ml (interquartile range: 7–29) using the Siemens TnI ultra assay and 49 pg/ml (31–74) using the Roche Elecsys high sensitive TnT assay. Markedly more patients exceeded the 99th percentile for TnT than for TnI (95% vs. 14%, p<0.0001). In a multivariate linear regression model, TnT was independently associated with age, gender, systolic dysfunction, time on dialysis, residual diuresis and systolic blood pressure, whereas TnI was independently associated with age, systolic dysfunction, pulse pressure, time on dialysis and duration of a HD session. During a follow-up period of nearly two years, TnT concentration above 38 pg/mL was associated with a 5-fold risk of death, whereas elevation of TnI had a gradual association to mortality.ConclusionIn hemodialysis patients, elevations of plasma troponin concentrations are explained by cardiac function and dialysis-related parameters, which contribute to cardiac strain. Both are highly predictive of increased risk of death.
Highlights
Elevations of cardiac troponins in the plasma define are indicative of myocardial injury and necrosis [1]
According to the universal definition of myocardial infarction (MI) published in 2007, MI can be diagnosed based on a rise and fall in the plasma troponin concentrations above the 99th percentile when there is evidence of myocardial ischemia [2]
The increased sensitivity and resolution of the assays, improve the chance to identify factors that are associated with elevated plasma troponin concentrations, such as loss of residual renal function [24] or volume overload [25], both of which contribute to cardiac strain and are predictive of increased mortality
Summary
Elevations of cardiac troponins in the plasma define are indicative of myocardial injury and necrosis [1]. In patients with end-stage renal failure (ESRD), chronic elevations at the subclinical level have been shown to occur without signs of myocardial ischemia [3,4,5]. A meta-analysis concluded that increases in plasma troponin T or troponin I concentrations conferred a 2.64 or 1.74-fold increase, respectively, in mortality risk in ESRD patients [11]. The cardiac work load of ESRD patients is greatly increased by several conditions, such as hypertension, shunt flow, chronic extracellular volume expansion, anemia or increased pulse pressure. These factors induce profound alterations in cardiac structure [16] and may lead to subsequent troponin release. The interpretation and relevance of this is still under debate
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