title: Cardiac troponin I and creatine kinase isoenzyme MB in patients with intradialytic hypotension.
abstract: BACKGROUND
  Intradialytic hypotension (IH) has been long recognized as a common complication during hemodialysis (HD) therapy, but few studies have discussed IH-related myocardial injuries and the long-term prognosis of patients prone to IH (HP).
  
  
  METHODS
  We conducted a prospective study on 70 chronic HD patients who had no recent occurrences of acute coronary artery syndrome. The patients were divided into two groups: HP (n = 29) and IH resistant (n = 41). While they underwent HD therapy, we monitored and evaluated their baseline data and their patterns of cardiac troponin I (cTnI), creatine kinase, and creatine kinase isoenzyme MB.
  
  
  RESULTS
  The HP and IH-resistant patients had similar baseline cardiac marker levels that did not seem to be influenced by uneventful HD therapy. However, if during HD therapy the patients experienced an episode of symptomatic IH, they were found to have significant increases in the creatine kinase MB activity at the end of HD therapy and in the cTnI levels 44 h following HD. After 12 months, the HP patients with baseline cTnI levels > or =0.20 ng/ml were more likely to experience cardiovascular events or death (adjusted odds ratio 15.0, p = 0.012).
  
  
  CONCLUSIONS
  Our study showed that, after symptomatic IH episodes, the HP patients were more likely to suffer occult myocardial injuries. HP patients who have high cTnI levels should be closely monitored for cardiovascular diseases.
authors.affiliation: Division of Nephrology, E-Da Hospital, I-Shou University and Shu-Zen College of Medicine and Management, Kaohsiung County, Taiwan.
authors.forename: Shih-Yuan
authors.initials: SY
authors.lastname: Hung
authors.forename: Yao-Min
authors.initials: YM
authors.lastname: Hung
authors.forename: Hua-Chang
authors.initials: HC
authors.lastname: Fang
authors.forename: Jeng-Hsien
authors.initials: JH
authors.lastname: Yeh
authors.forename: Gin-Chuan
authors.initials: GC
authors.lastname: Hung
authors.forename: Cheng-Ju
authors.initials: CJ
authors.lastname: Wu
authors.forename: Kang-Ju
authors.initials: KJ
authors.lastname: Chou
authors.forename: Hsiao-Min
authors.initials: HM
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D005260:Female; D006801:Humans; D007022:Hypotension / Q000097:blood* / Q000209:etiology*; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects*; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D007527:Isoenzymes; D019210:Troponin I; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form