Biological variation of cardiac troponin in stable haemodialysis patients

Mbagaya, Wycliffe; Luvai, Ahai; Lopez, Berenice

doi:10.1177/0004563215585877

Cited by 23 publications

(29 citation statements)

References 36 publications

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“…The CVi and RCV observed are close to the weekly (hs-cTnT and hs-cTnI) and monthly (hs cTnT and sensitive cTnI) data previously reported in HD patients [15,16]. They support the need to define different magnitude changes of cTn between HD patients and the general population, especially in absolute values.…”

Section: Discussionsupporting

confidence: 86%

Monthly reference change value of cardiac troponin in hemodialysis patients as a useful tool for long-term cardiovascular management

Badiou

Boudet

Leray‐Moragues³

et al. 2016

Clinical Biochemistry

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Section: Discussionsupporting

confidence: 86%

Monthly reference change value of cardiac troponin in hemodialysis patients as a useful tool for long-term cardiovascular management

Badiou

Boudet

Leray‐Moragues³

et al. 2016

Clinical Biochemistry

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“…The strengths of this study include serial measurements which allowed us to describe both short (one week) and long-term (12 months) TnT-changes in our cohort. Within-subject and between-subject coefficients of variation were similar to previous studies in HD patients using high-sensitivity TnTassays when comparing short-term estimates (27,28). Unlike most previous studies our study included intervention with an ARB, and patients were well characterized regarding cardiac status (e.g.…”

Section: Parameters Associated With Change In Tntsupporting

confidence: 62%

“…Detection limit is 5 ng/L with a total imprecision of less than 10% at a level of 13 ng/L, and in 616 healthy volunteers, the upper 99th percentile was 13.5 ng/L (25). Analytical within assay coefficient of variation in HD patients is approximately 1.7-6% according to previous studies (26)(27)(28). N-terminal pro b-type natriuretic peptide (NT-proBNP) methodology has previously been described in detail (21).…”

Section: Laboratory Proceduresmentioning

confidence: 99%

One-year Serial Measurements of High-sensitivity Troponin T in Hemodialysis Patients A Randomized Placebo-controlled Sub-study Investigating Angiotensin-II-Blockade, Variation Over Time and Associations with Clinical Outcome

Cd¹,

Kd²,

Kl³

et al. 2020

Preprint

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Background Troponin T (TnT) is a well-known risk factor for negative outcome in hemodialysis (HD) patients, but little is known about variation over time, and the impact of clinical and dialysis specific factors. This study investigated the effect of angiotensin II receptor blockade (ARB), short and long-term variation in TnT and associations with clinical parameters.Methods In this analysis based on the SAFIR-cohort (Clinical Trials ID: NCT00791830) 81 HD patients were randomized double-blind for placebo (n=40) or angiotensin II receptor blocker (ARB) treatment (n=41) with irbesartan (150-300 mg) and followed for 12 months with six serial measurements of TnT using a high-sensitivity assay. Results Fifty-four patients (67%) completed follow-up. Baseline TnT-medians (min-max) were (placebo/ARB): 45(14-295)/46(10-343)ng/L. ARB-treatment did not significantly affect mean TnT-levels over the 12-month study period. Median week-to-week and one-year TnT-variation (5th-95th-percentile range) using all samples regardless of intervention were: 0(-14-10)ng/L (week-to-week) and 3(-40-71)ng/L (12 months). Median TnT-amplitude, capturing the change from the lowest to the highest TnT-value observed during the one-year study period was 38% or 20.5 ng/L. Median ratios with 95% limits of agreement were: 1.00(0.73-1.37); P=0.92 (1 week/baseline; n=77) and 1.07(0.52-2.25); P=0.19 (12 months/baseline; n=54). Baseline TnT was positively correlated with diabetes, ultrafiltration volume, arterial stiffness, change in intradialytic total peripheral resistance and N-terminal pro b-type natriuretic peptide (NT-proBNP) and negatively correlated with hematocrit, residual renal function and change in intradialytic cardiac output. High baseline TnT was associated with a higher risk of admission and cardiovascular (CV) events during follow-up. Increase in TnT over time (ΔTnT=12-months-baseline) was significantly associated with increase in left ventricular (LV) mass and NT-proBNP and decrease in LV ejection fraction and late intradialytic stroke volume. ΔTnT was not significantly associated with admissions, CV or intradialytic hypotensive events during follow-up. Admissions were significantly more likely with a high (TnT-amplitude>20.5 ng/L) than a low TnT-amplitude. Peaks in TnT were less frequent in aspirin-treated patients. Conclusion ARB-treatment had no significant effect on TnT-levels. Week-to-week variation was generally low, yet over 12 months individual patients had considerable TnT fluctuations. Rise in TnT over time was significantly correlated with markers of cardiac deterioration.

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“…That was also seen in our patients since almost all of the study subjects had elevated levels of TnT-hs both pre-and post-dialysis. In one previous study of Mbagayasa et al, designed to evaluate a biological variation of cardiac troponin in stable HD patients, new-generation, serum high sensitivity troponin T was elevated in almost all patients, whereas troponin I was above normal range in only 30% of HD patients [9]. The mechanisms underlying troponin release in CKD include direct myocardial damage from circulating uremic endotoxins and an adverse metabolic milieu, subclinical epicardial or microvascular coronary artery disease (CAD) and heart failure, "demand" ischemia secondary to volume shifts and hemodynamic stressors during HD [10].…”

Section: Discussionmentioning

confidence: 94%

Wpływ stopnia nawodnienia oraz zmienności ciśnienia tętniczego krwi i częstości rytmu serca w czasie hemodializy na śróddializacyjne zmiany stężeń wysokoczułej troponiny T

Wajdlich

Podlejska²,

Rosół³

et al. 2017

Arterial Hypertension

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Effect of hydration status and variability of blood pressure and heart rate induced by hemodialysis on intradialytic changes of high sensitive troponin T Wpływ stopnia nawodnienia oraz zmienności ciśnienia tętniczego krwi i częstości rytmu serca w czasie hemodializy na śróddializacyjne zmiany stężeń wysokoczułej troponiny T AbstractIntroduction. High sensitivity troponin T (TnT-hs) is biomarker of myocardial damage and ischemia. Despite its elevation troponin still preserve its usefulness as a marker of the cardiovascular risk and mortality in chronic kidney disease. Variations of hydration status between and during hemodialysis exert significant hemodynamic effects, which may negatively affect cardiovascular system and blood pressure and lead to myocardial damage. The aim of the study was to access the effect of hydration status and variability of blood pressure and heart rate induced by hemodialysis on intradialytic changes of TnT-hs, in chronic hemodialysis patients. Material and methods. In 50 chronic hemodialysis patients (35M, 15F, mean age 64 ± 12 years) blood pressure and heart rate were monitored noninvasively during HD session. Serum concentration of TnT-hs and hydration status were assessed before and after hemodialysis.Results. TnT-hs concentration was above normal range in 98% patients before, and in all after hemodialysis. Median TnT-hs level was 82 ng/L before and 84 ng/L after hemodialysis, which comprised 586% and 600% of the upper limit of normal range. There was a small 2.4%, intradialytic increase of TnT-hs (p = 0.004). TnT-hs levels correlated positively with mean interdialytic weigh gain, before HD (r = 0.43, p = 0.02) and after HD (r = 0.5, p = 0.003).There was also a positive correlation between TnT-hs concentration and mean heart rate (r = 0.37, p = 0.008) and with mean systolic blood pressure during HD, before HD (r = 0.3, p = 0.026) and after HD (r = 0.3, p = 0.031). Conclusions. Hemodialysis can be a risk factor of myocardial injury, especially in overhydrated patients. Key words: hemodialysis, overhydration, troponin T, TnT-hs Arterial Hypertens. 2017, vol. 21, no. 4, pages: 186-194 DOI: 10.5603 StreszczenieWstęp. Wysokoczuła troponina T (TnT-hs) jest przydatnym klinicznie wskaźnikiem uszkodzenia komórek mięśnia sercowego. Stężenia TnT-hs u pacjentów z przewlekłą chorobą nerek są wyższe niż w populacji ogólnej, co wiąże się ze zwiększonym ryzykiem incydentów sercowo-naczyniowych oraz zgonu. Znaczne zmiany stopnia nawodnienia w czasie zabiegu hemodializy mogą niekorzystnie oddziaływać na układ sercowo-naczyniowy i ciśnienie tętnicze, co w efekcie może prowadzić do uszkodzenia kardiomiocytów. Celem pracy była ocena wpływu stanu nawodnienia, zmian częstości rytmu serca (HR) i ciśnienia tętniczego (BP) w trakcie hemodializy (HD) na zmiany stężeń TnT-hs powodowane zabiegiem hemodializy u pacjentów długotrwale hemodializowanych. Materiał i metody. U 50 pacjentów (35M, 15K, średnia wieku 64 ± 12 lat) z rozpoznaniem schyłkowej niewydolności nerek, długotrwale hemodializowanych, nieinwazy...

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Biological variation of cardiac troponin in stable haemodialysis patients

Cited by 23 publications

References 36 publications

Monthly reference change value of cardiac troponin in hemodialysis patients as a useful tool for long-term cardiovascular management

Monthly reference change value of cardiac troponin in hemodialysis patients as a useful tool for long-term cardiovascular management

One-year Serial Measurements of High-sensitivity Troponin T in Hemodialysis Patients A Randomized Placebo-controlled Sub-study Investigating Angiotensin-II-Blockade, Variation Over Time and Associations with Clinical Outcome

Wpływ stopnia nawodnienia oraz zmienności ciśnienia tętniczego krwi i częstości rytmu serca w czasie hemodializy na śróddializacyjne zmiany stężeń wysokoczułej troponiny T

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