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. 2022 Apr;26(2):166-175.
doi: 10.1111/hdi.12985. Epub 2021 Dec 13.

Monthly measurement of high-sensitivity cardiac troponins T and creatine kinase in asymptomatic chronic hemodialysis patients: A one-year prospective study

Stéphane Gremaud  1 , Benoît Fellay  2 , Ould Maouloud Hemett  1 , Jean-Luc Magnin  2 , Eric Descombes  1
Affiliations

Monthly measurement of high-sensitivity cardiac troponins T and creatine kinase in asymptomatic chronic hemodialysis patients: A one-year prospective study

Stéphane Gremaud et al. Hemodial Int. 2022 Apr.

Abstract

Background: Cardiology guidelines recommend measuring high-sensitivity cardiac troponin (hs-cTn) for the diagnostic work-up of acute coronary syndromes (ACS). Many hospitals measure hs-cTnT, but preliminary data have shown that hs-cTnT is higher than normal in many hemodialysis patients without evidence of ACS. The purpose of this study was therefore to determine the hs-cTnT levels every month for 1 year in asymptomatic hemodialysis patients, in order to assess their changes over time relative to creatine kinase.

Methods: Fourty-four hemodialysis patients (mean age 67 ± 14 years) were included. The predialysis levels of fifth-generation hs-cTnT, CK, and CK-MB were measured every month for 1 year using a Cobas® 6000 analyzer (Roche Diagnostics, Switzerland).

Results: Almost 100% of hs-cTnT measurements were higher than normal (N < 14 ng/L); the mean ± SD annual level was 84 ± 59 ng/L, ranging from a minimum of 24 ± 2 to 241 ± 28 ng/L in individual patients. The mean levels of CK and CK-MB were normal. Thirteen myocardial infarctions were analyzed, which were all associated with an initial elevation in hs-cTnT >45% from the individual baseline value. By comparison, CK and CK-MB only increased in 38% and 31% of these myocardial infarctions, respectively.

Discussion: hs-cTnT is persistently higher than normal in chronic hemodialysis patients. Standard algorithms for diagnosing ACS can obviously not be used and alternative diagnostic strategies need to be developed. According to our data, and given the huge variation in baseline hs-cTnT levels among patients, the use of higher cut-offs as proposed in the literature cannot be recommended. Instead, we consider that hs-cTnT should be checked at regular intervals (e.g., every 3-6 months) in order to establish individual baseline levels for hs-cTnT. This approach, in most instances, not only makes it possible to more rapidly rule-in but also to rapidly rule-out, cases of ACS in hemodialysis patients who develop cardiac symptoms.

Keywords: biomarkers; creatine kinase; hemodialysis; high-sensitivity cardiac troponin T; myocardial infarction.

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Conflict of interest statement

All authors declare that there is no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Time course of the mean ± SD levels of hs‐cTnT, CK, and CK‐MB during the study year. Normal levels are <14 ng/L, <170 U/L, and < 25 U/L, respectively
FIGURE 2
FIGURE 2
Distribution of the predialysis hs‐cTnT levels during the study years (n = 570, normal level < 14 ng/L)
FIGURE 3
FIGURE 3
Box‐and‐whisker plot of the hs‐cTnT levels during the study year. The boxes indicate the 25th and 75th percentiles and the line inside the boxes is the median value. The lines extending from the top and bottom of each box indicate the minimum and maximum values, except for extreme outliers
FIGURE 4
FIGURE 4
Minimum (left), mean (center) and maximum (right) hs‐cTnT levels in the 44 patients during the study year
FIGURE 5
FIGURE 5
Time course of c‐TnT before and after the 13 episodes of ACS, with peak values at time 0. *One patient died a few days after the myocardial infarction
See this image and copyright information in PMC

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