title: Serum cardiac troponin T and effective blood flow in stable extracorporeal dialysis patients.
abstract: OBJECTIVE
  We examined the association between extracorporeal dialysis (ED)-related effective blood flow (eQB) and serum cardiac troponin T (cTnT) as a possible indicator of silent myocardial damage in stable ED patients.
  
  
  METHODS
  In a cross-sectional study, cTnT was determined in 247 ED patients dialyzed using stable eQB and dialysate flow (QD). In a prospective study, 91 patients were switched from low-flux (LF) to high-flux (HF) hemodialysis (HD), and subsequently, the eQB increased, and the QD decreased; 65 patients continued LF-HD with stable eQB and QD. Clinical/laboratory evaluations were performed at 0, 15, 36, and 53 weeks from the start of the study.
  
  
  RESULTS
  In the cross-sectional study, the main cTnT predictors were dialysis vintage, age, eQB, phosphorus, and C-reactive protein. Patients with cTnT levels in the highest quartile were excluded from the analysis, and subjects dialyzed with eQB ≤316 ml/min exhibited lower cTnT levels compared with patients dialyzed with higher eQB (P = 0.002). The all-cause and cardiac mortality rates of 154 patients, without changes in ED modality for up to 42 months, were associated with the initial cTnT concentrations but not with the initial eQB. In the prospective study, higher values for eQB and cTnT were observed during HF-HD at weeks 36 (P = 0.045) and 53 (P = 0.01) of the present study. The initial cTnT, ∆eQB, and ∆albumin influenced the ∆cTnT. The all-cause and cardiac mortality rates were not different between LF and HF groups at 21 months after the prospective study was completed.
  
  
  CONCLUSIONS
  In stable ED patients, higher eQB rates and QB/QD values might contribute to silent myocardial injury, particularly in patients with lower cTnT levels, but do not affect the outcome of ED patients.
authors.affiliation: Chair and Department of Nephrology, Transplantology and Internal Diseases, Poznan University of Medical Sciences, Al. Przybyszewskiego 49, 60-355, Poznan, Poland. alicja_grzegorzewska@yahoo.com.
authors.forename: Alicja E
authors.initials: AE
authors.lastname: Grzegorzewska
authors.affiliation: Fresenius Nephrocare Dialysis Center, Ostrów Wielkopolski, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Cieszyński
authors.affiliation: B/Braun Avitum Poland, Dialysis Center, Nowy Tomyśl, Poland.
authors.forename: Leszek
authors.initials: L
authors.lastname: Niepolski
authors.affiliation: Fresenius Nephrocare Dialysis Center, Pleszew, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kaczmarek
authors.affiliation: Chair and Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Sowińska
mesh_terms: D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000209:etiology / Q000401:mortality; D003326:Coronary Circulation / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism; D011044:Poland / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology*; D006435:Renal Dialysis; D015996:Survival Rate / Q000639:trends; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: Cardiac troponin T; Dialysate flow; Effective blood flow; Extracorporeal dialysis; Mortality