Key result
High-flux hemodialysis membranes clear cardiac troponins I and T more efficiently than low-flux membranes, indicating that sampling time and membrane type affect clinical interpretation.
Why the study?
Does the ultrafiltration coefficient of the dialysis membrane affect the clearance and post-dialysis levels of cardiac troponin I and T in patients on chronic hemodialysis?
Observational (n=34)
Does the ultrafiltration coefficient of the dialysis membrane affect the clearance and post-dialysis levels of cardiac troponin I and T in patients on chronic hemodialysis?
Sampling time and the ultrafiltration coefficient of the hemodialysis membrane significantly influence cardiac troponin levels, which must be considered when interpreting these biomarkers in hemodialysis patients.
Membrane type and sampling time warrant consideration in troponin interpretation for hemodialysis patients; leaves open need for prospective validation before practice change.
CONTEXT: The measurement of cardiac troponin I (TnI) and T (TnT) is essential to diagnose, guide therapy, and predict outcomes of the acute coronary syndrome. Increased levels of troponins, especially TnT, are frequently observed in patients on chronic hemodialysis (HD), reflecting ongoing and subclinical myocardial damage. OBJECTIVE: Because these markers are increasingly used for stratification of cardiac risk in these patients, their behavior during HD should be acknowledged to optimize their clinical usefulness. DESIGN: TnI and TnT were measured in 34 patients pre-HD and post-HD by either high- or low-flux membranes. The post-HD concentrations were corrected for hemoconcentration. RESULTS: Pre-HD levels above the 99th percentile reference limits of the general population of TnI (>0.06 ng/ mL) and TnT (>0.01 ng/mL) were observed in 9% (13% high-flux, 6% low-flux membranes) and 88% (94% high-flux; 83% low-flux membranes) of the patients, respectively. No significant difference was observed in mean pre-HD values between patients dialyzed by low- and high-flux membranes. The overall decrease post-HD of both troponins (-21% and -17% for TnI and TnT, respectively) only reached statistical significance in patients dialyzed by low-flux membranes (-27% and -37% for TnI and TnT, respectively). A significant correlation was observed between absolute variations of TnI and TnT pre-HD to post-HD. CONCLUSIONS: Results of our investigation attest that high-flux membranes clear both troponins more efficiently from circulation than low-flux membranes. Therefore, sampling time and ultrafiltration coefficient of the HD membrane should be regarded as potential sources of variability in the clinical interpretation of troponin measurement in HD patients.
No takes yet. Share an insight, caveat, or question.
Lippi et al. (2008) conducted an observational in Chronic hemodialysis (n=34). High-flux hemodialysis membrane vs. Low-flux hemodialysis membrane was evaluated on Post-hemodialysis decrease in cardiac troponin I and T. High-flux hemodialysis membranes clear cardiac troponins I and T more efficiently than low-flux membranes, indicating that sampling time and membrane type affect clinical interpretation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: