Effect of hemodialysis on traditional and innovative cardiac markers.
The diagnostic approach to acute coronary syndrome (ACS) is challenging in patients with impaired renal function since most serum biomarkers are commonly increased in this clinical setting. Cardiac troponin T (cTnT), creatine kinase isoenzyme MB (CK MB), myoglobin, and ischemia modified albumin (IMA), were assayed in 45 patients prehemodialysis (pre-HD) and posthemodialysis (post-HD), and results were adjusted for hemoconcentration. The pre-HD values of serum IMA and cTnT were above the respective diagnostic thresholds (IMA<85 K units/L; cTnT <0.03 ng/mL) in six (13%) and 27 (60%) patients undergoing chronic HD, respectively. A significant (105.0 vs. 79.0 K units/L, P<0.0001) and variable (+38%; 95% confidence interval [CI], 12-65%) increase of serum IMA was observed post-HD, whereas the other biomarkers significantly decreased (cTnT: 0.029 vs. 0.044 ng/mL, P=0.016; CK-MB: 2.33 vs. 2.50 microg/L, P<0.0001; myoglobin: 128.1 vs. 148.7 microg/L, P<0.0001). Biomarkers of myocardial injury, especially cTnT and IMA, might be used in HD patients, provided that an appropriate diagnostic interpretation is guarantee, according to individual baseine value, metabolism, and time of sampling. Moreover, IMA might be reliably applied to stratify the long-term risk of these patients, but not for diagnosing an ACS during or immediately post-HD.
Montagnana
Martina
M
Sezione di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Ospedale Policlinico G.B. Rossi, Verona, Italy. martina.montagnana@med.lu.se
Lippi
Giuseppe
G
Tessitore
Nicola
N
Salvagno
Gian Luca
GL
Targher
Giovanni
G
Gelati
Matteo
M
Lupo
Antonio
A
Guidi
Gian Cesare
GC
D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002318:Cardiovascular Diseases / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000097:blood; D009206:Myocardium / Q000201:enzymology / Q000378:metabolism*; D009211:Myoglobin / Q000097:blood; D006435:Renal Dialysis; D012709:Serum Albumin / Q000032:analysis; D020107:Troponin T / Q000097:blood
D015415:Biomarkers; D009211:Myoglobin; D012709:Serum Albumin; D020107:Troponin T; D052279:Creatine Kinase, MB Form