Kidney Week

Abstract: PUB424

Prospective Study on the Analysis of High-Sensitivity Troponin T in Patients with Hemodialysis: Cutoff Points and Cardiovascular Outcomes

Session Information

• Publication Only

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Eick, Renato Eorgeg, Hospital Moinhos de Vento, Porto Alegre, Brazil

Renato Eorgeg Eick, MD

• Werner, Priscila, Hospital Moinhos de Vento, Porto Alegre, Brazil

Priscila Werner, MD

• Sartori Pacini, Gabriel, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil

Gabriel Sartori Pacini, MD

• Kalil, Milton, Hospital Moinhos de Vento, Porto Alegre, Brazil

Milton Kalil, MD

• André, Mauricio Lutzky, Hospital Moinhos de Vento, Porto Alegre, Brazil

Mauricio Lutzky André

• Schuchmann, Renata Asnis, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil

Renata Asnis Schuchmann, MD

• Nasi, Luiz, Hospital Moinhos de Vento, Porto Alegre, Brazil

Luiz Nasi, MD, PhD

• Ferreira, Carlos Amaral, Hospital Moinhos de Vento, Porto Alegre, Brazil

Carlos Amaral Ferreira, MD, MSc

• Stein, Anna Cristina, Hospital Moinhos de Vento, Porto Alegre, Brazil

Anna Cristina Stein, PhD

• Melere, Camila Mosmann, Hospital Moinhos de Vento, Porto Alegre, Brazil

Camila Mosmann Melere, MD, MSc

• Saitovich, David, Hospital Moinhos de Vento, Porto Alegre, Brazil

David Saitovich

Background

Patients with chronic kidney disease on dialysis may present troponin levels above the normal value even outside the context of suspected acute myocardial infarction. Even so, there is no clear established cutoff value in this population. Our aim was to evaluate and determine the basal troponin levels of each patient with CKD dialysis in a reference dialysis center in addition to assess cardiovascular outcomes.

Methods

We prospectively included consecutive patients with CKD on dialysis at a tertiary center in Southern Brazil. Mean, median and standard deviations of high-sensitive troponin T were assessed. Also, we correlated these values with other variables such as age, sex, hemoglobin levels, and iron measures to predicte an increased risk of cardiovascular mortality and mortality for other causes. The Receiver Operating Characteristic (ROC) curve was used to estimate the best cutoff point for pre-dialysis troponin levels to predict death within 24 months.

Results

During two-year follow-up, 88 dialytic patients were included. Mean age was 67 years, and most participants were male (62%). The troponin value using the pre-hemodialysis median was 64.7ng/L. In patients with previous ischemic heart disease and/or diabetes, this value is statistically higher. When we relate troponin to chest pain during dialysis or need to emergency room visits due to chest pain and death, the probability of death within 24 months is significantly higher in patients with troponin levels equal to or above 83.3 (p<0.001). The cut off value of 83.3 ng/L has a sensitivity of 75%, specificity of 80.9%, positive predictive value of 53.9% and negative predictive value of 91%, with accuracy of 79.5% to predict long-term mortality.

Conclusion

In our sample a cut off level of hS-TnT greater than 83.3 ng/L was associated with cardiovascular mortality and for other causes. Determining the median troponin value of a hemodialysis service and the basal troponin value of patients can improve the management of care by reducing the time to diagnose AMI and to avoid unnecessary measures, if the value remains constant at the patient's baseline.