Abstract
BACKGROUND AND AIMS: Troponin is the preferred biomarker for diagnosing
acute myocardial infarction (AMI). The new generations of high-sensitive troponin
(hs-cTnI) assays are now the most commonly used including ultra-sensitive assays.
If, or how, haemodialysis influences troponin is still under debate. Failure to interpret
troponin values correctly during dialysis may lead to overlooked AMI´s thus putting patients’ lives at risk. The aim of this systematic review is to examine the literature
regarding the effect hemodialysis has on hs-cTnI.
METHOD: A systematic review was performed.
Inclusion criteria: measurement of hs-cTnI before and after dialysis in asymptomatic
patients. Full text articles only were eligible.
Exclusion criteria: posters, abstracts and articles in other languages than English.
JK and MH screened 1745 publications. In cases of conflict, FB was contacted
as a referee. A total of 153 articles were eligible for full text screening. The Quality
Assessment of Diagnostic Accuracy Studies 2 (QUADAS2) score was used in terms of
risk of bias and quality assessment.
RESULTS: Seven articles met the inclusion criteria (see Table 1). The sample size of
the included studies ranged from n = 13 to n =100 and n =310 in total. Two articles
investigated exclusively ultra-sensitive cTnI. One article examined both ultra-sensitive
cTnI and hs-cTnI. Three articles examined the effect of haemodiafiltration (HDF) on
hs-cTnI. In general, dialysis modalities were rarely described in detail. Only one article
showed an increase in hs-cTnI after four hours haemodialysis (HD)/haemodiafiltration
(HDF); however, hs-cTnI decreased significantly after 8 h. One study showed no
change in the control group in patients who were exposed to remote ischemic
preconditioning, although, a statistically insignificant 10% change in the background
population was displayed. Of the studies that found a decrease in hs-cTnI, the range
was from –3.4% to –36% with a significant decrease in four studies after 4 h HD/HDF.
Hs-cTnI concentrations were corrected differently in three articles using either
haematocrit concentration, total protein and albumin, or weight change after dialysis.
Corrections might make sense in the trial setting, but pose a challenge regarding how
to interpret troponin after dialysis in real life, where blood samples are not corrected
following dialysis.
The use of mean, median and different concentration corrections made subanalysis and meta-analysis impossible.
CONCLUSION: Most publications included in the review showed a decrease of hscTnI after dialysis. Diagnosing AMI is based on typical symptoms, signs of ischemia
in the ECG and a significant change of troponin (cTn) with at least one value above
the 99th percentile. A decrease of hs-cTnI during HD/HDF can alter the diagnostic
validity of troponin.
The level of significance of the decreased troponin is influenced by sample size,
which was low in general. However, it is very important to underline that one size
does not fit all. Further studies with larger sample sizes are needed for sub-analysis
for gender and age. Additionally, dialysis d
acute myocardial infarction (AMI). The new generations of high-sensitive troponin
(hs-cTnI) assays are now the most commonly used including ultra-sensitive assays.
If, or how, haemodialysis influences troponin is still under debate. Failure to interpret
troponin values correctly during dialysis may lead to overlooked AMI´s thus putting patients’ lives at risk. The aim of this systematic review is to examine the literature
regarding the effect hemodialysis has on hs-cTnI.
METHOD: A systematic review was performed.
Inclusion criteria: measurement of hs-cTnI before and after dialysis in asymptomatic
patients. Full text articles only were eligible.
Exclusion criteria: posters, abstracts and articles in other languages than English.
JK and MH screened 1745 publications. In cases of conflict, FB was contacted
as a referee. A total of 153 articles were eligible for full text screening. The Quality
Assessment of Diagnostic Accuracy Studies 2 (QUADAS2) score was used in terms of
risk of bias and quality assessment.
RESULTS: Seven articles met the inclusion criteria (see Table 1). The sample size of
the included studies ranged from n = 13 to n =100 and n =310 in total. Two articles
investigated exclusively ultra-sensitive cTnI. One article examined both ultra-sensitive
cTnI and hs-cTnI. Three articles examined the effect of haemodiafiltration (HDF) on
hs-cTnI. In general, dialysis modalities were rarely described in detail. Only one article
showed an increase in hs-cTnI after four hours haemodialysis (HD)/haemodiafiltration
(HDF); however, hs-cTnI decreased significantly after 8 h. One study showed no
change in the control group in patients who were exposed to remote ischemic
preconditioning, although, a statistically insignificant 10% change in the background
population was displayed. Of the studies that found a decrease in hs-cTnI, the range
was from –3.4% to –36% with a significant decrease in four studies after 4 h HD/HDF.
Hs-cTnI concentrations were corrected differently in three articles using either
haematocrit concentration, total protein and albumin, or weight change after dialysis.
Corrections might make sense in the trial setting, but pose a challenge regarding how
to interpret troponin after dialysis in real life, where blood samples are not corrected
following dialysis.
The use of mean, median and different concentration corrections made subanalysis and meta-analysis impossible.
CONCLUSION: Most publications included in the review showed a decrease of hscTnI after dialysis. Diagnosing AMI is based on typical symptoms, signs of ischemia
in the ECG and a significant change of troponin (cTn) with at least one value above
the 99th percentile. A decrease of hs-cTnI during HD/HDF can alter the diagnostic
validity of troponin.
The level of significance of the decreased troponin is influenced by sample size,
which was low in general. However, it is very important to underline that one size
does not fit all. Further studies with larger sample sizes are needed for sub-analysis
for gender and age. Additionally, dialysis d
| Originalsprog | Engelsk |
|---|---|
| Publikationsdato | 19. maj 2022 |
| Status | Udgivet - 19. maj 2022 |
| Begivenhed | 59th ERA Congress - Paris Expo Porte de Versailles, Paris, Frankrig Varighed: 19. maj 2022 → 22. maj 2022 |
Konference
| Konference | 59th ERA Congress |
|---|---|
| Lokation | Paris Expo Porte de Versailles |
| Land/Område | Frankrig |
| By | Paris |
| Periode | 19/05/2022 → 22/05/2022 |