A single hemodialysis session using a high-flux dialyzer significantly increased high-sensitivity cardiac troponin T plasma levels by a mean of 25.6% in patients with end-stage kidney disease and hypervolemia.
Cohort (n=20)
Yes
Does a single hemodialysis session using a high-flux dialyzer increase high-sensitivity cardiac troponin T (hs-cTnT) levels in patients with end-stage kidney disease and hypervolemia?
A single hemodialysis session significantly increases hs-cTnT levels in hypervolemic ESKD patients, indicating that pre-dialysis measurements should be used as the clinical baseline when evaluating for acute coronary syndrome.
Effect estimate: 25.6% mean rise (95% CI 4-18)
Absolute Event Rate: 155% vs 126%
p-value: p=0.0042
Background: High-sensitivity cardiac troponin T (hs-cTnT) is widely used in the diagnosis of acute coronary syndrome (ACS) because it is a marker of myocardial damage. Most patients with end-stage kidney disease (ESKD) on renal replacement therapy have elevated plasma hs-cTnT levels at baseline. The impact of hemodialysis (HD) on hs-cTnT levels remains unclear. This study aimed to determine the effect of HD in patients with ESKD and hypervolemia on plasma hs-cTnT levels. Methods: We conducted a retrospective study of ESKD patients admitted to two community hospitals over a three-year period (from January 1, 2020, to December 31, 2022). All patients had hypervolemia on admission. Plasma hs-cTnT levels were measured at admission and repeated 5.5 ± 0.75 hours after HD. Over the study period, 20 patients with ESKD and hypervolemia fulfilled the inclusion criteria. Two patients were diagnosed with ACS. Results: Pre-HD and post-HD hs-cTnT were elevated in 85% of patients. The data did not follow normal distribution. The median and interquartile range (IRQ) for pre-HD hs-cTnT was 126 (154) ng/L, and for post-HD hs-cTnT was 155 (234) ng/L. Following a single HD session with a high-flux dialyzer, hs-cTnT levels increased in 80% of the cohort, with a mean rise of 25.6% (p = 0.0042). Mean volume removal was 2.4 L, range (1-5 L). Two patients were diagnosed with ACS. Mortality over the study period was 40%, with cardiovascular disease as the leading cause of death. Conclusion: In ESKD patients with hypervolemia, a single HD session using a high-flux dialyzer significantly increased hs-cTnT plasma level. Pre-dialysis hs-cTnT measurements should be used as a clinical baseline when evaluating for ACS, and post-dialysis elevations should be interpreted with caution. Serial measurements may improve diagnostic accuracy. Further prospective studies are needed to clarify the mechanisms and clinical implications of these findings.
Tinawi et al. (Thu,) conducted a cohort in End-stage kidney disease with hypervolemia (n=20). Hemodialysis with high-flux dialyzer vs. Pre-hemodialysis baseline was evaluated on Change in plasma high-sensitivity cardiac troponin T (hs-cTnT) levels (25.6% mean rise, 95% CI 4-18, p=0.0042). A single hemodialysis session using a high-flux dialyzer significantly increased high-sensitivity cardiac troponin T plasma levels by a mean of 25.6% in patients with end-stage kidney disease and hypervolemia.