Cardiovascular risk markers in hemodialysis patients

Int J Artif Organs. 2004 Dec;27(12):1083-90. doi: 10.1177/039139880402701212.

Abstract

Cardiovascular events are the main cause of death in hemodialysis patients. Nevertheless, acute myocardial infarction may be misdiagnosed in uremic patients, because typical markers have a high rate of false positivity. A recent two-year prospective study showed that predialytic high serum concentrations of troponin T and CK-MB mass were associated with high mortality, cardiac mortality, myocardial infarction and unstable angina (MACEs). We studied 16 uremic patients (13 M; 3 W) on standard HD and 6 patients (4 M; 2 W) on on-line HDF, who had been taking folic acid for at least three months. Patients who suffered from acute or chronic cardiac ischemic disease were excluded. Anthropometric parameters, pre and post-dialytic pH, HCO3 and electrolytes did not differ between the two groups. Kt/V and URR% were lower in conventional HD vs on-line HDF (p < 0.04; p < 0.04). ORR% was strongly elevated in on-line HDF compared with HD (p < 0.005). In conventional HD, ORR% was directly correlated with Kt/V and URR% (r = 0.49, p < 0.04; r = 0.48, p < 0.04, respectively). Even in on-line HDF ORR% was directly correlated with Kt/V and URR% (r = 0.79, p < 0.04; r = 0.76, p < 0.05, respectively). Troponin I and CK-MB mass were not significantly different in pre vs post-dialysis, both in standard HD and on-line HDF. Nevertheless, in standard HD postdialytic troponin I correlated with serum sodium concentration (r = 0.93, p < 0.000), potassium (r = 0.67, p < 0.004) and serum chlorine (r = 0.92, p < 0.92, p < 0.000). CK-MB mass showed a correlation with serum chlorine (r = 0.49, p < 0.05). Postdialytic CK-MB mass correlated with serum potassium in on-line HDF (r = 0.83, p < 0.03). Our data suggest that hemodialytic treatments, both standard HD and on-line HDF, do not modify serum troponin I and CK-MB mass. Consequently, we can use these parameters for the diagnostic approach in acute or chronic ischemic heart disease in hemodialysis patients.

MeSH terms

  • Aged
  • Cardiovascular Diseases / epidemiology*
  • Creatine Kinase / blood*
  • Creatine Kinase, MB Form
  • Female
  • Homocysteine / blood
  • Humans
  • Isoenzymes / blood*
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / epidemiology*
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / epidemiology
  • Myocardial Ischemia / diagnosis*
  • Myocardial Ischemia / epidemiology
  • Renal Dialysis
  • Risk Factors
  • Troponin I / blood*
  • Uremia / blood
  • Uremia / epidemiology
  • Uremia / therapy

Substances

  • Isoenzymes
  • Troponin I
  • Homocysteine
  • Creatine Kinase
  • Creatine Kinase, MB Form