Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Krietemeyer, B.
Troponin I Kinetics in Patients Treated with Ambulatory Hemodialysis
Humanmedizin; [ Diplomarbeit ] Medizinische Universitaet Graz; 2024. pp. 70
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Kirsch Alexander
- Kolland Michael
- Altmetrics:
- Abstract:
- INTRODUCTION: Whereas cardiac troponins play a fundamental role in the latest guidelines for the diagnosis of myocardial infarction (MI), their evaluation in patients requiring hemodialysis (HD) is afflicted with several challenges. Beside the commonly elevated baseline levels of both clinically relevant subtypes, troponin I and troponin T, in this population, a further uncertainty exists in relation to troponin dynamics during HD and whether effects vary between different membranes and HD modalities. The new generation of medium cut-off membranes, that show higher permeability for middle sized molecules, add an additional layer of complexity to this topic. Due to this lack of clarity, physicians are confronted with ambiguity regarding the evaluation of troponin levels in HD patients presenting with signs of acute coronary syndrome (ACS). METHODS: In this controlled, randomized single-center trial, the baseline values of high-sensitive troponin I (hs-cTnI) and the effect of four different dialysis modalities (high-flux HD, low-flux HD, medium cut-off HD and hemodiafiltration) on hs-cTnI levels were investigated in a cross-over study design. Therefore, blood samples for hs-cTnI measurement were taken at baseline, one hour after dialysis start and at the end of every session. Baseline levels of hs-cTnI as well as dynamics in hs-cTnI over time were analyzed. RESULTS: Nineteen patients were included in the statistical analysis (10 [52.6 %] male; age 31–81, median 66). The baseline hs-cTnI was elevated above the cut-off value for MI in 58.3 % (median 34.25 ng/l; IQR 15.25–121.96) of all cases. Patients with cardiovascular disease presented higher hs-cTnI levels compared to those without (p<.001). There was no effect of dialysis with high-flux, medium cut-off membranes or HDF on hs-cTnI levels (p>.05). In contrast, low-flux HD led to an increase of hs-cTnI levels during one session (Z=2.12; r =.499; p=.034), but not during the first hour (p=.227). This observation could not be shown after correction for hemoconcentration. CONCLUSION:Dialysis sessions conducted with low-flux membranes may lead to an increase in hs-cTnI levels and therefore complicate interpretation of hs-cTnI levels in HD patients presenting with ACS. Other HD modalities also lead to inconclusive effects in relation of hs-cTnI dynamics since we observed interpersonal variations in hs-cTnI dynamics in both directions. Thus, the interpretation of hs-cTnI in patients undergoing HD is afflicted with a high risk of misinterpretation. Since the majority of HD patients present with baseline hs-cTnI levels above the cut-off value for MI, the interpretation of single hs-cTnI values in this population should be done with particular caution.