Key result
Hemodialysis significantly increased serum ischemia modified albumin (105.0 vs. 79.0 K units/L, P<0.0001), while significantly decreasing cTnT, CK-MB, and myoglobin levels.
Why the study?
Does hemodialysis affect the levels of traditional and innovative cardiac markers in patients undergoing chronic hemodialysis?
Observational (n=45)
Does hemodialysis affect the levels of traditional and innovative cardiac markers in patients undergoing chronic hemodialysis?
Effect estimate: +38% increase (95% CI 12-65)
Absolute Event Rate: 105% vs 79%
p-value: p=<0.0001
Hemodialysis significantly alters cardiac biomarker levels, increasing IMA and decreasing cTnT, CK-MB, and myoglobin, necessitating individualized interpretation for ACS diagnosis in this population.
HD-associated biomarker shifts may complicate ACS diagnosis in dialysis patients; leaves open validation of adjusted thresholds in prospective studies.
The diagnostic approach to acute coronary syndrome (ACS) is challenging in patients with impaired renal function since most serum biomarkers are commonly increased in this clinical setting. Cardiac troponin T (cTnT), creatine kinase isoenzyme MB (CK MB), myoglobin, and ischemia modified albumin (IMA), were assayed in 45 patients prehemodialysis (pre-HD) and posthemodialysis (post-HD), and results were adjusted for hemoconcentration. The pre-HD values of serum IMA and cTnT were above the respective diagnostic thresholds (IMA<85 K units/L; cTnT <0.03 ng/mL) in six (13%) and 27 (60%) patients undergoing chronic HD, respectively. A significant (105.0 vs. 79.0 K units/L, P<0.0001) and variable (+38%; 95% confidence interval [CI], 12-65%) increase of serum IMA was observed post-HD, whereas the other biomarkers significantly decreased (cTnT: 0.029 vs. 0.044 ng/mL, P=0.016; CK-MB: 2.33 vs. 2.50 microg/L, P<0.0001; myoglobin: 128.1 vs. 148.7 microg/L, P<0.0001). Biomarkers of myocardial injury, especially cTnT and IMA, might be used in HD patients, provided that an appropriate diagnostic interpretation is guarantee, according to individual baseine value, metabolism, and time of sampling. Moreover, IMA might be reliably applied to stratify the long-term risk of these patients, but not for diagnosing an ACS during or immediately post-HD.
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Montagnana et al. (2008) conducted an observational in Chronic hemodialysis (n=45). Hemodialysis vs. Pre-hemodialysis baseline was evaluated on Serum ischemia modified albumin (IMA) levels (K units/L) (+38% increase, 95% CI 12-65, p=<0.0001). Hemodialysis significantly increased serum ischemia modified albumin (105.0 vs. 79.0 K units/L, P<0.0001), while significantly decreasing cTnT, CK-MB, and myoglobin levels.