Key result
Hemodialysis with low-flux membranes significantly decreased cardiac troponin I and T levels post-dialysis (-27% and -37%, respectively), highlighting membrane type as a source of variability.
Why the study?
Does the ultrafiltration coefficient of the dialysis membrane (high-flux vs low-flux) affect the clearance of cardiac troponin I and T in patients on chronic hemodialysis?
Observational (n=34)
Does the ultrafiltration coefficient of the dialysis membrane (high-flux vs low-flux) affect the clearance 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 for cardiac risk stratification in hemodialysis patients.
Low-flux membranes were associated with post-dialysis troponin reductions; leaves open effects on cardiac risk stratification in hemodialysis.
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.
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Lippi et al. (2008) conducted an observational in chronic hemodialysis (n=34). High-flux dialysis membranes vs. Low-flux dialysis membranes was evaluated on Decrease in cardiac troponin I and T levels post-hemodialysis. Hemodialysis with low-flux membranes significantly decreased cardiac troponin I and T levels post-dialysis (-27% and -37%, respectively), highlighting membrane type as a source of variability.
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