13
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found
      Is Open Access

      Serum cardiac troponin T and effective blood flow in stable extracorporeal dialysis patients

      International Urology and Nephrology
      Springer
      cardiac troponin t, dialysate flow, effective blood flow, extracorporeal dialysis, mortality

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Purpose We examined the association between extracorporeal dialysis (ED)-related effective blood flow (eQB) and serum cardiac troponin T (cTnT) as a possible indicator of silent myocardial damage in stable ED patients. Methods In a cross-sectional study, cTnT was determined in 247 ED patients dialyzed using stable eQB and dialysate flow (QD). In a prospective study, 91 patients were switched from low-flux (LF) to high-flux (HF) hemodialysis (HD), and subsequently, the eQB increased, and the QD decreased; 65 patients continued LF-HD with stable eQB and QD. Clinical/laboratory evaluations were performed at 0, 15, 36, and 53 weeks from the start of the study. Results In the cross-sectional study, the main cTnT predictors were dialysis vintage, age, eQB, phosphorus, and C-reactive protein. Patients with cTnT levels in the highest quartile were excluded from the analysis, and subjects dialyzed with eQB ≤316 ml/min exhibited lower cTnT levels compared with patients dialyzed with higher eQB (P = 0.002). The all-cause and cardiac mortality rates of 154 patients, without changes in ED modality for up to 42 months, were associated with the initial cTnT concentrations but not with the initial eQB. In the prospective study, higher values for eQB and cTnT were observed during HF-HD at weeks 36 (P = 0.045) and 53 (P = 0.01) of the present study. The initial cTnT, ∆eQB, and ∆albumin influenced the ∆cTnT. The all-cause and cardiac mortality rates were not different between LF and HF groups at 21 months after the prospective study was completed. Conclusion In stable ED patients, higher eQB rates and QB/QD values might contribute to silent myocardial injury, particularly in patients with lower cTnT levels, but do not affect the outcome of ED patients. Electronic supplementary material The online version of this article (doi:10.1007/s11255-015-1165-z) contains supplementary material, which is available to authorized users.

          Related collections

          Most cited references25

          • Record: found
          • Abstract: found
          • Article: not found

          Circulating endotoxemia: a novel factor in systemic inflammation and cardiovascular disease in chronic kidney disease.

          Translocated endotoxin derived from intestinal bacteria has a wide range of adverse effects on cardiovascular (CV) structure and function, driving systemic inflammation, atherosclerosis and oxidative stress. This study's aim was to investigate endotoxemia across the spectrum of chronic kidney disease (CKD). Circulating endotoxin was measured in 249 patients comprising CKD stage 3 to 5 and a comparator cohort of hypertensive patients without significant renal impairment. Patients underwent extended CV assessment, including pulse wave velocity and vascular calcification. Hemodialysis (HD) patients also received detailed echocardiographic-based intradialytic assessments. Patients were followed up for 1 year to assess survival. Circulating endotoxemia was most notable in those with the highest CV disease burden (increasing with CKD stage), and a sharp increase was observed after initiation of HD. In HD patients, predialysis endotoxin correlated with dialysis-induced hemodynamic stress (ultrafiltration volume, relative hypotension), myocardial stunning, serum cardiac troponin T, and high-sensitivity C-reactive protein. Endotoxemia was associated with risk of mortality. CKD patients are characteristically exposed to significant endotoxemia. In particular, HD-induced systemic circulatory stress and recurrent regional ischemia may lead to increased endotoxin translocation from the gut. Resultant endotoxemia is associated with systemic inflammation, markers of malnutrition, cardiac injury, and reduced survival. This represents a crucial missing link in understanding the pathophysiology of the grossly elevated CV disease risk in CKD patients, highlighting the potential toxicity of conventional HD and providing a novel set of potential therapeutic strategies to reduce CV mortality in CKD patients.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Prognostic value of cardiac troponin in patients with chronic kidney disease without suspected acute coronary syndrome: a systematic review and meta-analysis.

            Clinicians face uncertainty about the prognostic value of troponin testing in patients with chronic kidney disease (CKD) without suspected acute coronary syndrome (ACS).
              Bookmark
              • Record: found
              • Abstract: found
              • Article: found
              Is Open Access

              Sensitive Troponins – Which Suits Better for Hemodialysis Patients? Associated Factors and Prediction of Mortality

              Background In hemodialysis patients, elevated plasma troponin concentrations are a common finding that has even increased with the advent of newly developed sensitive assays. However, the interpretation and relevance of this is still under debate. Methods In this cross-sectional study, we analyzed plasma concentrations of sensitive troponin I (TnI) and troponin T (TnT) in stable ambulatory hemodialysis patients (n = 239) and investigated their associations with clinical factors and mortality. Results In all of the enrolled patients, plasma TnI or TnT was detectable at a median concentration of 14 pg/ml (interquartile range: 7–29) using the Siemens TnI ultra assay and 49 pg/ml (31–74) using the Roche Elecsys high sensitive TnT assay. Markedly more patients exceeded the 99th percentile for TnT than for TnI (95% vs. 14%, p<0.0001). In a multivariate linear regression model, TnT was independently associated with age, gender, systolic dysfunction, time on dialysis, residual diuresis and systolic blood pressure, whereas TnI was independently associated with age, systolic dysfunction, pulse pressure, time on dialysis and duration of a HD session. During a follow-up period of nearly two years, TnT concentration above 38 pg/mL was associated with a 5-fold risk of death, whereas elevation of TnI had a gradual association to mortality. Conclusion In hemodialysis patients, elevations of plasma troponin concentrations are explained by cardiac function and dialysis-related parameters, which contribute to cardiac strain. Both are highly predictive of increased risk of death.
                Bookmark

                Author and article information

                Journal
                26603871
                4769722
                10.1007/s11255-015-1165-z
                http://creativecommons.org/licenses/by/4.0/

                Nephrology
                cardiac troponin t,dialysate flow,effective blood flow,extracorporeal dialysis,mortality

                Comments

                Comment on this article