Hemodialysis and biomarkers of myocardial infarction - a cohort study

Rasmus Bo Hasselbalch*, Bashir Alaour, Jonas Henrik Kristensen, Liam S Couch, Thomas E Kaier, Ture Lange Nielsen, Louis Lind Plesner, Nina Strandkjær, Morten Schou, Casper Rydahl, Jens P Goetze, Henning Bundgaard, Michael Marber, Kasper Karmark Iversen

*Corresponding author for this work

Abstract

OBJECTIVES: End-stage renal disease is associated with a high risk of cardiovascular disease. We compared the concentration and prognostic ability of high sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) and cardiac myosin-binding protein C (cMyC) among stable hemodialysis patients.

METHODS: Patients were sampled before and after hemodialysis. We measured hs-cTnI, hs-cTnT and cMyC and used Cox regressions to assess the association between quartiles of concentrations and all-cause mortality and a combination of cardiovascular events and all-cause mortality during follow-up.

RESULTS: A total of 307 patients were included, 204 males, mean age 66 years (SD 14). Before dialysis, 299 (99 %) had a hs-cTnT concentration above the 99th percentile, compared to 188 (66 %) for cMyC and 35 (11 %) for hs-cTnI. Hs-cTnT (23 %, p<0.001) and hs-cTnI (15 %, p=0.049) but not cMyC (4 %, p=0.256) decreased during dialysis. Follow-up was a median of 924 days (492-957 days); patients in the 3rd and 4th quartiles of hs-cTnT (3rd:HR 3.0, 95 % CI 1.5-5.8, 4th:5.2, 2.7-9.8) and the 4th quartile of hs-cTnI (HR 3.8, 2.2-6.8) had an increased risk of mortality. Both were associated with an increased risk of the combined endpoint for patients in the 3rd and 4th quartiles. cMyC concentrations were not associated with risk of mortality or cardiovascular event.

CONCLUSIONS: Hs-cTnT was above the 99th percentile in almost all patients. This was less frequent for hs-cTnI and cMyC. High cTn levels were associated with a 3-5-fold higher mortality. This association was not present for cMyC. These findings are important for management of hemodialysis patients.

Original languageEnglish
JournalClinical Chemistry and Laboratory Medicine
Volume62
Issue number2
Pages (from-to)361-370
Number of pages10
ISSN1434-6621
DOIs
Publication statusPublished - 26 Jan 2024

Keywords

  • Aged
  • Biomarkers
  • Cohort Studies
  • Humans
  • Male
  • Myocardial Infarction/diagnosis
  • Renal Dialysis
  • Troponin I
  • Troponin T

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