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Do cardiac troponins provide prognostic insight in hemodialysis patients?
Can J Cardiol. 2003 Jul; 19(8):907-11.CJ

Abstract

BACKGROUND

The diagnosis of myocardial necrosis in patients with chronic renal failure is often difficult because biochemical markers of cardiac damage such as creatine kinase MB (CKMB) and cardiac troponin T (cTnT) may be spuriously elevated. Recent small studies also report unexplained elevations in cardiac troponin I (cTnI) in chronic renal failure patients undergoing hemodialysis. The relative incidence of elevated cardiac troponins in this population and their relationship to clinical events remain unknown.

OBJECTIVE

To determine the incidence and prognostic significance of asymptomatic elevations of cTnT and cTnI in patients undergoing hemodialysis for chronic renal failure.

DESIGN

Prospective cohort study.

SETTING

University tertiary care teaching hospital.

PATIENTS

One hundred thirteen patients over 21 years of age undergoing onsite hemodialysis were enrolled between December 1997 and February 1998.

MEASUREMENTS

All-cause and cardiovascular mortality, hospitalization for acute myocardial infarction, unstable angina or congestive heart failure, new onset sustained arrhythmia or need for unscheduled emergency hemodialysis due to volume overload at 30 days and six months.

RESULTS

The incidence of abnormal results for cTnT, cTnI and CKMB were 42%, 15% and 4%, respectively. Independent predictors of mortality at six months were median age greater than 63 years (odds ratio 14.3, 95% CI 1.5 to 130.3, P=0.019) and positive cTnT (odds ratio 13.6, 95% CI 2.5 to 73.2, P=0.002). Diabetics were more likely to have positive cTnI and cTnT results than nondiabetics (P<0.001 and P=0.023, respectively).

CONCLUSIONS

cTnT is commonly elevated in patients with chronic renal failure even in the absence of acute coronary syndromes. cTnT may be an important independent prognostic marker in patients on hemodialysis for chronic renal failure. While less common, elevations of cTnI are more frequent than CKMB elevations. The basis of these cardiac troponin elevations is unclear. These findings may represent, in part, a subclinical myocardial injury, an inflammatory response to chronic renal failure or a chronically volume overloaded state.

Authors+Show Affiliations

Division of Cardiology, University of Alberta Hospital, Edmonton, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

12876611

Citation

Choy, Jonathan B., et al. "Do Cardiac Troponins Provide Prognostic Insight in Hemodialysis Patients?" The Canadian Journal of Cardiology, vol. 19, no. 8, 2003, pp. 907-11.
Choy JB, Armstrong PW, Ulan RA, et al. Do cardiac troponins provide prognostic insight in hemodialysis patients? Can J Cardiol. 2003;19(8):907-11.
Choy, J. B., Armstrong, P. W., Ulan, R. A., Campbell, P. M., Gourishankar, S., Prosser, C. I., & Tymchak, W. J. (2003). Do cardiac troponins provide prognostic insight in hemodialysis patients? The Canadian Journal of Cardiology, 19(8), 907-11.
Choy JB, et al. Do Cardiac Troponins Provide Prognostic Insight in Hemodialysis Patients. Can J Cardiol. 2003;19(8):907-11. PubMed PMID: 12876611.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Do cardiac troponins provide prognostic insight in hemodialysis patients? AU - Choy,Jonathan B, AU - Armstrong,Paul W, AU - Ulan,Raymond A, AU - Campbell,Patricia M, AU - Gourishankar,Sita, AU - Prosser,Connie I, AU - Tymchak,Wayne J, PY - 2003/7/24/pubmed PY - 2003/8/23/medline PY - 2003/7/24/entrez SP - 907 EP - 11 JF - The Canadian journal of cardiology JO - Can J Cardiol VL - 19 IS - 8 N2 - BACKGROUND: The diagnosis of myocardial necrosis in patients with chronic renal failure is often difficult because biochemical markers of cardiac damage such as creatine kinase MB (CKMB) and cardiac troponin T (cTnT) may be spuriously elevated. Recent small studies also report unexplained elevations in cardiac troponin I (cTnI) in chronic renal failure patients undergoing hemodialysis. The relative incidence of elevated cardiac troponins in this population and their relationship to clinical events remain unknown. OBJECTIVE: To determine the incidence and prognostic significance of asymptomatic elevations of cTnT and cTnI in patients undergoing hemodialysis for chronic renal failure. DESIGN: Prospective cohort study. SETTING: University tertiary care teaching hospital. PATIENTS: One hundred thirteen patients over 21 years of age undergoing onsite hemodialysis were enrolled between December 1997 and February 1998. MEASUREMENTS: All-cause and cardiovascular mortality, hospitalization for acute myocardial infarction, unstable angina or congestive heart failure, new onset sustained arrhythmia or need for unscheduled emergency hemodialysis due to volume overload at 30 days and six months. RESULTS: The incidence of abnormal results for cTnT, cTnI and CKMB were 42%, 15% and 4%, respectively. Independent predictors of mortality at six months were median age greater than 63 years (odds ratio 14.3, 95% CI 1.5 to 130.3, P=0.019) and positive cTnT (odds ratio 13.6, 95% CI 2.5 to 73.2, P=0.002). Diabetics were more likely to have positive cTnI and cTnT results than nondiabetics (P<0.001 and P=0.023, respectively). CONCLUSIONS: cTnT is commonly elevated in patients with chronic renal failure even in the absence of acute coronary syndromes. cTnT may be an important independent prognostic marker in patients on hemodialysis for chronic renal failure. While less common, elevations of cTnI are more frequent than CKMB elevations. The basis of these cardiac troponin elevations is unclear. These findings may represent, in part, a subclinical myocardial injury, an inflammatory response to chronic renal failure or a chronically volume overloaded state. SN - 0828-282X UR - https://www.unboundmedicine.com/medline/citation/12876611/Do_cardiac_troponins_provide_prognostic_insight_in_hemodialysis_patients L2 - https://medlineplus.gov/kidneyfailure.html DB - PRIME DP - Unbound Medicine ER -