Influence of sampling time and ultrafiltration coefficient of the dialysis membrane on cardiac troponin I and T.

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.