Nephrology Dialysis Transplantation, Vol 14, Issue 6 1489-1495, Copyright © 1999 by Oxford University Press
M Mockel, R Schindler, L Knorr, C Muller, G Heller, T Stork and U Frei
Background: Moderate elevations of cardiac troponin
(Tn) T, up to levels presumably diagnostic for minor myocardial damage, are
suspected to be false positive in nearly 0.3 of end-stage renal disease
(ESRD) patients undergoing haemodialysis (HD). It is not clear whether
cardiac TnI is superior to TnT in those patients, if differences between
ESRD and pre-ESRD occur, and what the prognostic meaning of these troponin
elevations might be. Subjects and methods: We examined
40 chronic renal-disease patients [56.4 SD 13.9 years; 22 male, 18 female)
without evidence of an acute coronary syndrome (ACS) for at least 28 days
prior to the investigation. Cardiac status was determined by history,
physical examination, ECG and echocardiography. Patients were divided into
subgroups with HD (n=20) and without HD (n=20). Patients without HD had a
mean creatinine clearance (CC) of 13.45 ml/min. Tn were measured by
immunoassay techniques. TnT was compared to two different TnI tests (TnID,
TnIB), CK/CKMB activity and myoglobin (MYO) concentrations. In all
patients, a 9-month follow-up for acute myocardial infarction,
re-hospitalization, and death was completed. Results:
None of the troponins significantly predicted patient outcome. Tn did not
corelate with CC (r<0.6). Applying the lowest reported threshold
values for all tests in the HD group, 0.3 patients were positive for TnT,
0.55 patients were positive for TnID, and 0.15 for TnIB. In the group
without HD, 0.2 patients were positive for TnT and TnID and 0.1 for TnIB.
Conclusions: Moderate elevations of cardiac troponins
are common in clinically stable patients with renal disease and are neither
diagnostic for an acute coronary syndrome nor predictive of outcome. It is
concluded that increased troponins in asymptomatic renal patients are of
questionable value for risk stratification, most probably due to unspecific
elevations. Key words: haemodialysis; outcome; renal
disease; troponin T; troponin I
ORIGINAL ARTICLES
Prognostic value of cardiac troponin T and I elevations in renal disease patients without acute coronary syndromes: a 9-month outcome analysis
Department of Nephrology/Intensive Care Medicine and Clinical Chemistry Institute, Charité/Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; Institute of Medical Sociology and Social Medicine, Philipps-University of Marburg, Germany; Department of Cardiology/Angiology/Intensive Care Medicine, Karl Olga Hospital, Stuttgart, Germany; Corresponding author
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