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Variation of High-Sensitivity Troponin T Results in Patients Undergoing Continuous Renal Replacement Therapy:

Published on Jan 1, 2019in Canadian journal of kidney health and disease
路 DOI :10.1177/2054358119828386
Vikas Srinivasan Sridhar (U of T: University of Toronto), Michael Chen (McGill University)+ 2 AuthorsSharon J. Nessim13
Estimated H-index: 13
(McGill University)
Abstract
Background:Cardiac troponins are the preferred biomarker to diagnose myocardial injury. Complicating the interpretation of serial troponins in patients with end-stage renal disease, it has been shown that the hemodialysis procedure results in a small but significant decline in high-sensitivity cardiac troponins (hs-cTnT). This raises the possibility that continuous renal replacement therapy (CRRT) might similarly alter cardiac troponin levels and affect their interpretation when cardiac ischemia is being considered.Objective:We sought to determine the effect of CRRT on hs-cTnT levels over time in a group of patients without active myocardial injury.Design:Prospective, observational studySetting:Single tertiary care hospital, Montreal, QuebecPatients:Ten critically ill patients with acute kidney injury (AKI) undergoing CRRT. Cardiac ICU (intensive care unit) patients and acute coronary syndrome patients were excluded from the study. The CRRT prescription was at the discretion of the treating intensivist an...
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References10
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#1Michael Chen (JGH: Jewish General Hospital)H-Index: 3
#2Howard Gerson (JGH: Jewish General Hospital)H-Index: 1
Last. Elizabeth MacNamara (JGH: Jewish General Hospital)H-Index: 4
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Cardiac troponin (cTn) is essential for the diagnosis of an acute coronary syndrome (ACS). However, in end-stage renal disease (ESRD) baseline cTn levels are often elevated, and it is unknown whether the hemodialysis (HD) procedure affects cTn levels. This leaves clinicians unsure of how to interpret cTn in HD patients with cardiac ischemia. We therefore sought to determine if plasma levels of high-sensitivity cardiac troponin T (hs-cTnT) vary during or after HD treatment. We prospectively enrol...
4 CitationsSource
#1Alma M.A. Mingels (UM: Maastricht University)H-Index: 11
#2Eline P.M. Cardinaels (UM: Maastricht University)H-Index: 6
Last. Otto Bekers (UM: Maastricht University)H-Index: 24
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BACKGROUND:We have found previously that in acute myocardial infarction (AMI), cardiac troponin T (cTnT) is degraded in a time-dependent pattern. We investigated whether cTnT forms differed in patients with chronic cTnT increases, as seen with renal dysfunction, from those in the acute phase of myocardial infarction. METHODS:We separated cTnT forms by gel filtration chromatography (GFC) in end-stage renal disease (ESRD) patients: prehemodialysis (pre-HD) and post-HD (n = 10) and 2 months follow-...
15 CitationsSource
#1Eric Hoste (UGent: Ghent University)H-Index: 55
#2Sean M. Bagshaw (U of A: University of Alberta)H-Index: 61
Last. John A. Kellum (University of Pittsburgh)H-Index: 93
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Purpose Current reports on acute kidney injury (AKI) in the intensive care unit (ICU) show wide variation in occurrence rate and are limited by study biases such as use of incomplete AKI definition, selected cohorts, or retrospective design. Our aim was to prospectively investigate the occurrence and outcomes of AKI in ICU patients.
467 CitationsSource
4 CitationsSource
AKI is associated with an increased risk of adverse outcomes, including short-term and long-term mortality, incident CKD, accelerated progression to end-stage renal disease and reduced health-related quality of life. The incidence of the disorder is increasing rapidly worldwide. In this Review, the authors discuss the epidemiology, outcomes and economic impact of AKI in developed and developing countries.
239 CitationsSource
#1David Song (Auckland City Hospital)H-Index: 2
#2Janak de Zoysa (North Shore Hospital)H-Index: 11
Last. Weldon Chiu (Auckland City Hospital)H-Index: 4
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AbstractAim: To investigate and describe cardiac troponins in subjects with acute kidney injury (AKI). Methods: A prospective observational study of troponin in subjects presenting with AKI in a tertiary hospital. Creatine kinase-MB (CKMB), troponin I (Abbott Laboratories), and troponin T (Roche 4th generation) were measured. Patients with conditions known to cause elevated troponin levels were excluded. Results: Nineteen subjects were enrolled in the study. Six subjects had troponin I and T con...
11 CitationsSource
#1Alan H.B. Wu (UCSF: University of California, San Francisco)H-Index: 79
#2Allan S. Jaffe (Mayo Clinic)H-Index: 79
Last. Christopher P. CannonH-Index: 134
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Over the past decade, cardiac troponin (cTn)1 has become the cornerstone laboratory medicine measurement for assessment of myocardial infarction (MI) in suspected acute coronary syndrome (ACS) patients. In the past 5鈥7 years, methods for measuring the natriuretic peptide B-type natriuretic peptide (BNP) and its inert cometabolite N-terminal proBNP (NT-proBNP) have become available, and much knowledge has accumulated regarding their clinical use in the context of heart failure and hemodynamic str...
196 CitationsSource
#1Bryan R. Conway (Edin.: University of Edinburgh)H-Index: 16
#2Maureen McLaughlinH-Index: 1
Last. John HartyH-Index: 2
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Background. Patients undergoing chronic haemodialysis frequently have elevated serum cardiac troponin T (cTnT) levels resulting in difficulty in diagnosing acute coronary syndromes (ACS) in these patients. We sought to determine whether: (i) cTnT concentrations were consistent over time; (ii) intradialytic changes in cTnT levels were due to haemoconcentration; (iii) baseline cTnT levels predicted subsequent mortality or ACS. Methods. We measured serial pre- and post-dialysis cTnT concentrations ...
56 CitationsSource
#1Nadia A. Khan (U of A: University of Alberta)H-Index: 33
#2Brenda R. Hemmelgarn (U of A: University of Alberta)H-Index: 7
Last. Adeera Levin (U of A: University of Alberta)H-Index: 1
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Background鈥 The prognostic usefulness of troponin enzymes in end-stage renal disease (ESRD) patients is controversial. To resolve this uncertainty of troponin as a prognostic tool, we conducted a systematic review to quantify the association between elevated troponin I or T and long-term total mortality among ESRD patients not suspected of having acute coronary syndrome. Methods and Results鈥 We conducted an unrestricted search from the MEDLINE, EMBASE, and DARE bibliographic databases to Decembe...
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#1Alice SchmidtH-Index: 22
#2Thomas StefenelliH-Index: 1
Last. Gert MayerH-Index: 33
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The prevalence of coronary artery disease (CAD) is high in patients on renal replacement therapy; therefore, reliable noninvasive screening tests are needed. We retrospectively determined the sensitivity, specificity, and positive and negative likelihood ratios (LRs) for a history of chest pain, resting and exercise electrocardiography (ECG), thallium dipyridamole scintigraphy, and echocardiography in 42 patients undergoing chronic hemodialysis and 42 patients after renal transplantation who als...
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