Theory and Practice in Medicine, 2015 Vol. 21 No. 4.3
HIGH SPECIFICITY TROPONIN INCREASE IN HEMODIALYSIS PATIENTS. VILNIUS CITY CLINICAL HOSPITAL DATA
Dainora Kubiliūtė, Elita Gruodytė
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Key words: troponin, chronic kidney disease, hemodialysis, acute coronary sindrome.
Cardiac disease is the major cause of death in patients with end-stage renal disease, accounting for ~45 % of all deaths. Diagnosing an acute coronary syndrome in these patients is often difficult because the troponin levels are increased in patients with renal failure in the absence of clinical myocardial ischemia symptoms.
Objective. To assess the amount of troponin in Vilnius City Clinical Hospital Dialysis section patients, to compare the troponin value with biochemistry analysis and cardiac echocardiography results.Material and methods. Crossectional examination conducted in August 2015. Criteria for patient selection: stable, without acute coronary syndrome and without acute infection symptoms. The final analysis contained 41 patients. Gender distribution: 57.1 % (24) males and 40.5 % (17) women. The mean age was 66.7 years (SD – 13.6 years). Executed blood tests: troponin, creatinin, urea, electrolytes, CRB, hemoglobin. Last year echocardioscopy data was used to evaluate heart structural impairement. Evaluated troponin relation with blood test results, heart structural impairement and duration of hemodialysis.
Results. Average amount of troponin 87.9 ng/l (SD – 66,1 ng/ ml). During the analysis of troponin quantity of links to the dialysis patient age, duration of hemodialysis, laboratory values, cardiac structural changes and myocardial infarction statistically significant difference between the groups was not detected, however, it should be noted, the greatest amount of troponin containing group (Group 5) provided most subjects of suffered a myocardial infarction – 90 % (4 of 5), the
difference was statistically significant (p = 0.03). Weak direct relation is established between the amount of troponin and CRP (r = 0.2) – increasing the level of C-reactive protein, troponin increases, but the relation is not statistically significant (p > 0.05) Statistically significant (p < 0.05 ), a moderate inverse relation (r -0.345) is obtained by comparing the level of troponin, and left ventricular ejection fraction – decreases left ventricular ejection fraction, increased level of troponin.
Conclusions. All patients diagnosed with chronic kidney disease and undertaking dialysis found with increased troponin level. Patients with structural changes in the heart (reduced left ventricular fraction, myocardial infarction) had statistically significant troponin level increase. Troponin increases, increasing the level of C-reactive protein, but the relation is not statistically
October 5, 2015. Accepted:
October 26, 2015.