Aim: The majority of patients with end-stage renal disease have chronically elevated concentrations of troponins, thus obscuring the diagnosis of myocardial infarction. We conducted a prospective study to examine the impact of hemodialysis on the level of high-sensitivity cardiac troponins T in asymptomatic patients with end-stage renal disease.
Methods: High-sensitivity cardiac troponins T were measured in 43 patients, before and after three dialysis sessions, over a one week period.
Results: Following dialysis, an average decrease of 7.6 pg/mL in high-sensitivity cardiac troponin T levels was observed which represents a 10.3% drop from baseline. Mutlivariable mixed linear regression models taking into account dialysis session (session 1, 2 or 3), sampling moment (before and after dialysis) and repeated measures on individuals revealed that the presence of coronary artery disease and elevated body mass index were associated with higher high-sensitivity cardiac troponin T levels when the other variables were held constant (CAD: β [fixed effect estimate]=31.13 pg/mL, P=0.022, 95%CI 4.46-57.80; body mass index: β=2.57 kg/m2, P=0.008, 95%CI 0.68-4.46). The significant fixed effect estimate for the interaction between gender and sampling moment indicated that the drop in high-sensitivity cardiac troponin T levels following dialysis was greater for women than for men (β=5.75, P=0.049, 95% CI 0.02-11.47). When controlling for the variables mentioned above, this analysis confirmed that hemodialysis accounted for an 11.31 pg/mL decrease in high-sensitivity cardiac troponin T levels (P<0.001, 95%CI -15.99 - -6.62) and that the values were higher in the first dialysis session than in the third (P=0.007; 95%CI 1.62-9.79). Ten patients (23%) were found to have no decrease or an increase in troponin levels after hemodialysis.
Conclusion: In stable asymptomatic patients with end-stage renal disease, we have shown that hemodialysis reduces the blood concentration of high-sensitivity cardiac troponins T by at least 10%. Further studies are needed to confirm these results and determine their prognostic significance.