Key result
Hemodiafiltration lowers hs-cTnT up to ~41%, while low-flux hemodialysis increases levels.
Why the study?
Interpreting serial cardiac troponin T is difficult in patients with ESRD suspected of ACS, and the effect of different RRT modalities on hs-cTnT is important to determine.
How do different modalities of renal replacement therapy (LF-HD, HF-HD, HDF) affect the blood concentration of high-sensitive cardiac troponin T in patients with ESRD?
Systematic Review
How do different modalities of renal replacement therapy (LF-HD, HF-HD, HDF) affect the blood concentration of high-sensitive cardiac troponin T in patients with ESRD?
The type of renal replacement therapy significantly affects hs-cTnT levels, with low-flux hemodialysis increasing and hemodiafiltration decreasing concentrations, which must be considered when evaluating ESRD patients for acute coronary syndrome.
Dialysis modality must inform hs-cTnT interpretation for ACS in ESRD; confirms differential biomarker effects across renal replacement therapies.
INTRODUCTION: Patients with end-stage renal disease (ESRD) have an increased risk of cardiovascular disease, but interpreting cardiac troponin is difficult in this population. The effect of renal replacement therapy (RRT) is important to consider when interpreting serial cardiac troponin T (cTnT) results for patients with ESRD suspected of acute coronary syndrome (ACS). The aim of this systematic review is to answer how low-flux hemodialysis (LF-HD), high-flux hemodialysis (HF-HD), and hemodiafiltration (HDF) affect the blood concentration of high-sensitive cardiac troponin T (hs-cTnT). METHOD: Several databases were searched and identified records were evaluated independently by two of the authors. Pre- and postdialysis hs-cTnT concentrations together with other relevant data were extracted from the included studies. The quality (potential bias and applicability issues) were assessed for each of the included studies. RESULTS: The literature search identified 2,540 records and 15 studies were included. The relative pre- to postdialysis change of hs-cTnT varied from -41 to 29%. LF-HD increased the hs-cTnT concentration with relative changes between 2 and 17%. HDF decreased the concentration with relative changes from -41% to -9%. Both increases and decreases were seen for HF-HD (-16% to 12%). DISCUSSION/CONCLUSION: In this systematic review, we found LF-HD to increase the hs-cTnT concentration and HDF to decrease the concentration. Results for HF-HD and unspecified HD are more heterogeneous. Because of the differences between the included studies, a meta-analysis was not meaningful. This systematic review can help with the assessment of patients with ESRD suspected of ACS in relation to hemodialysis/HDF treatment.
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Hunderup et al. (2023) conducted a systematic review in End-stage renal disease (ESRD). Hemodialysis (low-flux, high-flux) and hemodiafiltration vs. Pre-dialysis baseline was evaluated on Relative pre- to postdialysis change of hs-cTnT. Low-flux hemodialysis increased hs-cTnT concentrations (2% to 17%), while hemodiafiltration decreased them (-41% to -9%), with heterogeneous effects (-16% to 12%) for high-flux hemodialysis.
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