Open AccessElevation of Highly Sensitive Cardiac Troponin T Among End-Stage Renal Disease Patients Without Acute Coronary Syndrome
Author(s) -
Wan Nur Aimi Wan Mohd Zamri,
Noorazliyana Shafii,
Tuan Salwani Tuan Ismail,
Adlin Zafrulan Zakaria,
Najib Majdi Yaacob,
Noor Azlin Azraini Che Soh
Publication year - 2021
Publication title -
the malaysian journal of medical sciences/the malaysian journal of medical science
Language(s) - English
Resource type - Journals
eISSN - 2180-4303
pISSN - 1394-195X
DOI - 10.21315/mjms2021.28.5.6
Subject(s) - medicine , interquartile range , acute coronary syndrome , end stage renal disease , myocardial infarction , troponin t , cardiology , peritoneal dialysis , troponin complex , continuous ambulatory peritoneal dialysis , population , troponin , hemodialysis , dialysis , kidney disease , coronary artery disease , environmental health
Background: In end-stage renal disease (ESRD), troponin T concentrations can be elevated even without cardiac ischaemia, which hampers the diagnosis of acute myocardial infarction (AMI). The objectives of our study were to determine the proportion of dialysisdependent ESRD patients without acute coronary syndrome (ACS) but with highly sensitive cardiac troponin T (hs-cTnT) levels above the 99th percentile upper reference limit and to evaluate the range of hs-cTnT among this population. Methods: A cross-sectional study was conducted at the haemodialysis (HD) unit of a tertiary hospital in Malaysia from January 2018 to February 2019. Dialysis-dependent ESRD patients were included and those with a recent history of ACS (within 30 days) were excluded. Pre-dialysed serum hs-cTnT levels were measured using Cobas e411. The upper limit of the 99th percentile value for troponin T was 14 ng/L. Results: A total of 150 patients were recruited as study participants. The majority were female (62%) and of Malay ethnicity (94%), and the mean (SD) age was 45.19 (16.36) years old. The hs-cTnT range (min, max) was 11.39–738.30 ng/L and the median (interquartile range [IQR]) of hs-cTnT was 59.20 (83.41) ng/L. Elevated hs-cTnT levels were observed in 149/150 (99%) of the study participants (54/55 [98.2%] of the patients were on HD, and 95/95 [100.0%] of the patients were on continuous ambulatory peritoneal dialysis). Conclusion: This study supports prior research showing that even without ACS, most ESRD patients have elevated concentrations of cardiac troponin. Furthermore, our study illustrates the need to revisit the use of absolute troponin values when making a diagnosis of ACS in ESRD patients.