A comparison of markers of myocardial injury and their relation to nutritional parameters in hemodialysis patients.
BACKGROUND
Serum cardiac troponin T (cTnT) is a valuable marker of ischemic heart disease (IHD) and left ventricular hypertrophy, as well as a mortality predictor in hemodialysis populations. We compared the value of cTnT, creatinine kinase (CK)-MB mass and myoglobin as mortality predictors in our hemodialysis patients and evaluated their relation to nutritional status.


METHODS
A total of 118 hemodialysis patients were prospectively studied from January 2004 to April 2013. Clinical and laboratory evaluations during the 12-month baseline period included the history of IHD, signs of left ventricular hypertrophy (LVH), Kt/V and serum cardiac markers together with the percentage of body fat (%fat), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), triceps skinfold (TSF) and BMI.


RESULTS
Underweight patients had significantly higher cTnT values (Mann-Whitney, p<0.05). Correlation analysis (Spearman) showed an inverse association between cTnT and TSF (ρ=-0.22, p<0.05), as well as between CK-MB mass and TSF (ρ=-0.26, p<0.01). In men cTnT also correlated inversely with %fat (ρ=-0.27, p<0.05) and BMI (ρ=-0.33, p<0.05). In addition, myoglobin was correlated significantly with MAC, MAMC and albumin. Among cardiac markers cTnT was the only independent variable predicting mortality (Multivariate Cox regression, HR=1.04 CI (1.01-1.07); p<0.01; measurement units 0.01 μg/L).


CONCLUSIONS
Troponin T and CK-MB mass were significantly elevated in the underweight patient group. Troponin T was the only independent cardiac marker predictor of all cause mortality in our hemodialysis patients.
Clinic of Nephrology, Clinical Center of Serbia , Belgrade , Serbia and.
Milan D
MD
Stosovic
Sanja Dj
SDj
Stankovic
Mirjana Lj
MLj
Stanojevic
Sanja P
SP
Simic-Ogrizovic
Dijana B
DB
Jovanovic
Radomir T
RT
Naumovic
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001835:Body Weight; D052279:Creatine Kinase, MB Form / Q000097:blood*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status / Q000502:physiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D006435:Renal Dialysis; D055771:Serbia / Q000453:epidemiology; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D020107:Troponin T; D052279:Creatine Kinase, MB Form
Anthropometry; cardiac markers; hemodialysis; nutrition