Elevated cardiac troponin T in hemodialysis patients receiving more intravenous iron sucrose.
Elevated cardiac troponin T (cTnT) has been associated with shorter survival in hemodialysis patients. Moreover, intravenous (IV) iron treatment has been held responsible for oxidative stress and accelerated atherosclerosis in these patients. In the present study, we investigated the relationship between cTnT concentration, IV iron treatment, and parameters of iron status. In addition, parameters of oxidative stress, inflammation, and atherosclerosis were evaluated. Predialysis blood samples of 78 chronic hemodialysis patients were analyzed for cTnT, malondialdehyde, creatine kinase (CK), and CK-isoenzyme MB (CK-MB). In addition, the mean value of predialysis serum samples collected during the last year, were considered for homocysteine, ferritin, iron, iron binding capacity, blood cell counts, blood urea nitrogen, creatinine, albumin, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), calcium, phosphate, iPTH, cholesterol, and triglyceride. The quantity of IV iron sucrose administered during the last two years was counted from the patients' files. Echocardiography, all events related to ischemic heart disease, and urine volume were also recorded. Elevated cTnT levels (> or =0.10 ng/mL) were found in 18 patients (23.1%). The amount of iron administered was 2264+/-1871 mg with a range 0-7000 mg. Patients with elevated cTnT levels received more IV iron than those with normal cTnT (3692+/-1771 vs. 1761+/-1595 mg, p<0.001). The serum ferritin level was higher in patients with elevated cTnT (median levels; 477 vs. 288 ng/mL; P<0.05). Patients with elevated cTnT were longer on dialysis compared to those with normal levels (median times; 35.5 vs. 15 months, P<0.01) and regression analysis identified the amount of administered iron as an independent factor for elevated cTnT (P<0.01). Intravenous iron treatment and high ferritin concentration are related to high cTnT level, which has previously been incriminated as a survival marker in hemodialysis patients.
Guz
Galip
G
Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey. galip_guz@hotmail.com
Sahinarslan
Asife
A
Dhondt
Annemieke Willy Clarisse
AW
Bagdatoglu
Oktay
O
Kavutcu
Mustafa
M
Reis
Kadriye Altok
KA
Yalçin
Ridvan
R
Bali
Musa
M
Sindel
Sükrü
S
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001774:Blood Chemical Analysis; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D005260:Female; D005290:Ferric Compounds / Q000008:administration & dosage*; D000077605:Ferric Oxide, Saccharated; D005500:Follow-Up Studies; D005937:Glucaric Acid; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012016:Reference Values; D006435:Renal Dialysis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D005290:Ferric Compounds; D020107:Troponin T; D000077605:Ferric Oxide, Saccharated; D005937:Glucaric Acid