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Cardiac high-sensitivity Troponin T measurement: a layer of complexity in managing haemodialysis patients.
MedLine Citation:
PMID:  22694299     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
SUMMARY AT A GLANCE: In stable asymptomatic HD patients, highly sensitive TNT is persistently elevated above normal values and is not affected by dialysis. Highest values were evident in those with cardiovascular disease. It is recommended that in at risk individuals on HD, a baseline hsTNT should be measured for future comparison in an acute event. ABSTRACT: Aim:  To determine: a) the proportion of stable asymptomatic haemodialysis patients with elevated troponin, b) stability of troponin values after dialysis and over a two-week interval, and c) whether high-sensitivity troponin T (hsTnT) was associated with higher prevalence of cardiovascular risk factors or cardiovascular disease in these patients. Methods:  We measured hsTnT and the fourth generation troponin I before and after dialysis in 103 stable in-centre haemodialysis patients without ischaemic symptoms. Patients were divided into quartiles to test for associations with established cardiovascular risk factors or disease. Results:  hsTnT was above the 99th percentile for the general population in 99% of haemodialysis patients compared with only 13% elevation for the troponin I assay (p<0.001). Median pre-dialysis hsTnT concentrations were unchanged after a two-week interval (69 vs. 69 ng/L, p=0.55) but fell slightly immediately following dialysis (69 vs. 61 ng/L, p<0.001). Established coronary artery disease (59% vs. 22%), peripheral vascular disease (38 vs. 4%) and diabetes (18 vs. 7%) were more prevalent (p< 0.05) in those in the highest quartile for hsTnT compared to those in the lowest quartile. Conclusions:  Almost all in-centre haemodialysis patients have elevated troponin T in their baseline stable state and this appears unchanged over a two-week interval. Such a high rate of baseline elevation of hsTnT may lead to confusion in managing acute coronary syndrome in this group of patients, particularly when symptoms are atypical. We recommend that if Troponin I assay is unavailable then baseline hsTnT concentrations are measured periodically in all haemodialysis patients. © 2012 The Authors. Nephrology © 2012 Asian Pacific Society of Nephrology.
Authors:
Timothy J Pianta; Andrea R Horvath; Vivienne M Ellis; Rina Leonetti; Christine Moffat; Elizabeth A Josland; Mark A Brown
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-13
Journal Detail:
Title:  Nephrology (Carlton, Vic.)     Volume:  -     ISSN:  1440-1797     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9615568     Medline TA:  Nephrology (Carlton)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 The Authors. Nephrology © 2012 Asian Pacific Society of Nephrology.
Affiliation:
Departments of Renal Medicine, Chemical Pathology (South East Area Laboratory Service SEALS), Medicine, St George Hospital, University of New South Wales, Sydney, NSW, Australia; Department of Clinical Chemistry (SEALS) Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia.
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