Importance of High-Sensitivity Troponin T in clinically stable Haemodialysis Patients

Abstract

Chronic kidney disease (CKD) is a significant and growing public health problem, responsible for substantial burden of illness and premature mortality. It is considered the ninth leading cause of death in the United States. It is a common condition in which there is a progressive loss of renal function that may eventually reach the stage of kidney failure over time. Patients with chronic kidney disease (CKD) are at high risk for acute coronary syndrome (ACS) including acute myocardial infarction (AMI) and cardiovascular death, as they are predisposed to accelerated atherosclerosis compared to the general population. An AMI is often a lethal event in patients with CKD; two year post-myocardial infarction mortality rates have reported to be up to 73% in patients with end stage renal disease. For patients treated with haemodialysis, several factors remain unknown with the introduction of a more sensitive troponin T assay. These include the proportion of stable dialysis patients with chronic troponin T elevation, the variability of these measurements following and between dialysis sessions and the prognostic value of elevated levels for cardiovascular disease and cardiovascular risk. The aim of the present study was to determine the expected values of high-sensitivity troponin T (hs-TnT) in patients on haemodialysis and to measure its variation over a dialysis session. Our study was conducted at Dar Alshefaa on thirty (30) cases of clinically stable haemodialysis patients. Samples were collected immediately before and immediately after the termination of dialysis session.These data were compared to the data obtained from thirty (30) healthy individuals serving as a control group. Patients were further subdivided according to duration of dialysis into patients who have undergone dialysis for less than and more than 4 years and also subdivided according to history of CAD into patients with positive and patients with negative history of CAD. All Subjects under study were subjected to full history taking, thorough clinical examination and the following laboratory investigations: complete blood count (CBC), complete renal profile (serum creatinine, urea, uric acid, calcium, inorganic phosphorus and albumin) and measurment of high-sensitivity Troponin T (hs-TnT). Results of this study revealed that pre-dialysis (baseline) hs-TnT concentrations was statistically significant higher in haemodialysis patients than the healthy controls. In addition, our study revealed that 100% of ESRD patients showed hs-TnT concentrations above the 99th percentile of healthy controls with a limit of 11 ng/L. There were a highly statistical significant difference between pre- and post-dialysis levels of hs-TnT concentrations. Values were decreased after dialysis session. Also, there were no statistical significant difference between baseline hs-TnT levels and different durations of dialysis. High-sensitivity troponin T concentrations was not affected by years of dialysis. In our study, hs-TnT levels were higher in patients with positive history of CAD when compared to patients with negative history of CAD although this elevation didn’t reach statistical significant difference. Moreover, The present study demonstrated a non-significant correlation between baseline hs-TnT levels and all other studied parameters (urea, creatinine, uric acid, calcium, inorganic phosphorus, albumin, haemoglobin, duration of dialysis).