Sensitive troponins--which suits better for hemodialysis patients? Associated factors and prediction of mortality.
BACKGROUND
In hemodialysis patients, elevated plasma troponin concentrations are a common finding that has even increased with the advent of newly developed sensitive assays. However, the interpretation and relevance of this is still under debate.


METHODS
In this cross-sectional study, we analyzed plasma concentrations of sensitive troponin I (TnI) and troponin T (TnT) in stable ambulatory hemodialysis patients (n = 239) and investigated their associations with clinical factors and mortality.


RESULTS
In all of the enrolled patients, plasma TnI or TnT was detectable at a median concentration of 14 pg/ml (interquartile range: 7-29) using the Siemens TnI ultra assay and 49 pg/ml (31-74) using the Roche Elecsys high sensitive TnT assay. Markedly more patients exceeded the 99th percentile for TnT than for TnI (95% vs. 14%, p<0.0001). In a multivariate linear regression model, TnT was independently associated with age, gender, systolic dysfunction, time on dialysis, residual diuresis and systolic blood pressure, whereas TnI was independently associated with age, systolic dysfunction, pulse pressure, time on dialysis and duration of a HD session. During a follow-up period of nearly two years, TnT concentration above 38 pg/mL was associated with a 5-fold risk of death, whereas elevation of TnI had a gradual association to mortality.


CONCLUSIONS
In hemodialysis patients, elevations of plasma troponin concentrations are explained by cardiac function and dialysis-related parameters, which contribute to cardiac strain. Both are highly predictive of increased risk of death.
Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University of Tuebingen, Germany. ferruh.artunc@med.uni-tuebingen.de
Ferruh
F
Artunc
Christian
C
Mueller
Tobias
T
Breidthardt
Raphael
R
Twerenbold
Andreas
A
Peter
Claus
C
Thamer
Peter
P
Weyrich
Hans-Ulrich
HU
Haering
Bjoern
B
Friedrich
D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood; D011379:Prognosis; D006435:Renal Dialysis / Q000379:methods / Q000401:mortality; D012307:Risk Factors; D019210:Troponin I / Q000097:blood*; D020107:Troponin T / Q000097:blood*
D019210:Troponin I; D020107:Troponin T