title: Cardiovascular risk markers in hemodialysis patients.
abstract: Cardiovascular events are the main cause of death in hemodialysis patients. Nevertheless, acute myocardial infarction may be misdiagnosed in uremic patients, because typical markers have a high rate of false positivity. A recent two-year prospective study showed that predialytic high serum concentrations of troponin T and CK-MB mass were associated with high mortality, cardiac mortality, myocardial infarction and unstable angina (MACEs). We studied 16 uremic patients (13 M; 3 W) on standard HD and 6 patients (4 M; 2 W) on on-line HDF, who had been taking folic acid for at least three months. Patients who suffered from acute or chronic cardiac ischemic disease were excluded. Anthropometric parameters, pre and post-dialytic pH, HCO3 and electrolytes did not differ between the two groups. Kt/V and URR% were lower in conventional HD vs on-line HDF (p < 0.04; p < 0.04). ORR% was strongly elevated in on-line HDF compared with HD (p < 0.005). In conventional HD, ORR% was directly correlated with Kt/V and URR% (r = 0.49, p < 0.04; r = 0.48, p < 0.04, respectively). Even in on-line HDF ORR% was directly correlated with Kt/V and URR% (r = 0.79, p < 0.04; r = 0.76, p < 0.05, respectively). Troponin I and CK-MB mass were not significantly different in pre vs post-dialysis, both in standard HD and on-line HDF. Nevertheless, in standard HD postdialytic troponin I correlated with serum sodium concentration (r = 0.93, p < 0.000), potassium (r = 0.67, p < 0.004) and serum chlorine (r = 0.92, p < 0.92, p < 0.000). CK-MB mass showed a correlation with serum chlorine (r = 0.49, p < 0.05). Postdialytic CK-MB mass correlated with serum potassium in on-line HDF (r = 0.83, p < 0.03). Our data suggest that hemodialytic treatments, both standard HD and on-line HDF, do not modify serum troponin I and CK-MB mass. Consequently, we can use these parameters for the diagnostic approach in acute or chronic ischemic heart disease in hemodialysis patients.
authors.affiliation: Unità Operativa di Nefrologia e Dialisi, Ospedale S. Marta e S. Venera, Acireale CT, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Urso
authors.forename: M
authors.initials: M
authors.lastname: Garozzo
authors.forename: F
authors.initials: F
authors.lastname: Milone
authors.forename: G
authors.initials: G
authors.lastname: Battaglia
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003402:Creatine Kinase / Q000097:blood*; D052279:Creatine Kinase, MB Form; D005260:Female; D006710:Homocysteine / Q000097:blood; D006801:Humans; D007527:Isoenzymes / Q000097:blood*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000453:epidemiology; D006435:Renal Dialysis; D012307:Risk Factors; D019210:Troponin I / Q000097:blood*; D014511:Uremia / Q000097:blood / Q000453:epidemiology / Q000628:therapy
chemical_list: D007527:Isoenzymes; D019210:Troponin I; D006710:Homocysteine; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form