Journal Mobile Options
Table of Contents
Vol. 103, No. 4, 2006
Issue release date: July 2006
Nephron Clin Pract 2006;103:c129–c136
(DOI:10.1159/000092909)

Troponin I Testing in Dialysis Patients Presenting to the Emergency Room: Does Troponin I Predict the 30-Day Outcome?

Bueti J. · Krahn J. · Karpinski M. · Bohm C. · Fine A. · Rigatto C.
Section of Nephrology, St. Boniface General Hospital, Winnipeg, Canada

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Background: Troponins are often measured in acutely ill chronic dialysis patients admitted to the emergency room, irrespective of their clinical presentation. The significance of an elevated troponin level in this setting is unclear. Methods: We identified all chronic dialysis patients presenting over 1 year to a tertiary care hospital emergency room who also had at least one cardiac troponin I (cTnI) level determination. We evaluated presenting complaints, risk factors for cardiac disease, cTnI levels, and major cardiac events (MCE; occurrence of cardiovascular death, myocardial infarction, de novo heart failure, or coronary revascularization) within 30 days by chart review in 149 patients (79 on hemodialysis, 70 on peritoneal dialysis). Results: Chest pain was documented in only 29% of the patients. Twenty-two patients (15%) experienced an MCE. The incidence of an MCE was the same in patients with and without chest pain. A cTnI level >0.1 ng/l was a significant predictor of an MCE (odds ratio 15.2, 95% confidence interval CI 5.26, 43.6). The likelihood ratios for MCEs were 0.32 (CI 0.16, 0.63) for a cTnI level <0.1 ng/l, 0.72 (CI 0.09, 5.5) for cTnI concentrations 0.1–0.3 ng/l, 7.8 (CI 4.2, 15) for a cTnI level >0.3, and 11.7 (CI 4.4, 31) for a cTnI concentration >2.0 ng/l. Conclusion: In acutely ill chronic dialysis patients presenting to a hospital emergency room, an elevated cTnI level indicates an increased 30-day cardiac risk, regardless of their clinical presentation.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Foley RN, Parfrey PS, Sarnak MJ: Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998;32(5 Suppl 3):S112–S119.

    External Resources

  2. Adams JE 3rd, Bodor GS, Davila-Roman VG, Delmez JA, Apple FS, Ladenson JH, Jaffe AS: Cardiac troponin I: a marker with high specificity for cardiac injury. Circulation 1993;88:101–106.
  3. Hamm CW, Goldmann BU, Heeschen C, Kreymann G, Berger J, Meinertz T: Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I. N Engl J Med 1997;337:1648–1653.
  4. Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP, Fischer GA, Fung AY, Thompson C, Wybenga D, Braunwald E: Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med 1996;335:1342–1349.
  5. Lindahl B, Toss H, Siegbahn A, Venge P, Wallentin L: Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary artery disease. FRISC Study Group. Fragmin during Instability in Coronary Artery Disease. N Engl J Med 2000;343:1139–1147.
  6. Farkouh ME, Robbins MJ, Urooj Zafar M, Shimbo D, Davidson KW, Puttappa R, Winston J, Halperin JL, Epstein EM, Patel M, Talor Z, Chesebro JH: Association between troponin I levels and mortality in stable hemodialysis patients. Am J Med 2003;114:224–226.
  7. Choy JB, Armstrong PW, Ulan RA, Campbell PM, Gourishankar S, Prosser CI, Tymchak WJ: Do cardiac troponins provide prognostic insight in hemodialysis patients? Can J Cardiol 2003;19:907–911.
  8. Ishii J, Nomura M, Okuma T, Minagawa T, Naruse H, Mori Y, Ishikawa T, Kurokawa H, Hirano T, Kondo T, Nagamura Y, Ezaki K, Hishida H: Risk stratification using serum concentrations of cardiac troponin T in patients with end-stage renal disease on chronic maintenance hemodialysis. Clin Chim Acta 2001;312:69–79.
  9. Needham DM, Shufelt KA, Tomlinson G, Scholey JW, Newton GE: Troponin I and T levels in renal failure patients without acute coronary syndrome: a systematic review of the literature. Can J Cardiol 2004;20:1212–1218.
  10. Khan IA, Wattanasuwan N, Mehta NJ, Tun A, Singh N, Singh HK, Vasavada BC, Sacchi TJ: Prognostic value of serum cardiac troponin I in ambulatory patients with chronic renal failure undergoing long-term hemodialysis: a two-year outcome analysis. J Am Coll Cardiol 2001;38:991–998.
  11. Lang K, Schindler S, Forberger C, Stein G, Figulla HR: Cardiac troponins have no prognostic value for acute and chronic cardiac events in asymptomatic patients with end-stage renal failure. Clin Nephrol 2001;56:44–51.
  12. Wayand D, Baum H, Schätzle G, Scharf J, Neumeier D: Cardiac troponin T and I in end-stage renal failure. Clin Chem 2000;46:1345–1350.
  13. Porter GA, Norton T, Bennett WM: Long-term follow-up of the utility of troponin T to assess cardiac risk in stable chronic hemodialysis patients. Clin Lab 2000;46:469–476.
  14. Apple FS, Murakami MM, Pearce LA, Herzog CA: Predictive value of cardiac troponin I and T for subsequent death in end-stage renal disease. Circulation 2002;106:2941–2945.
  15. Möckel M, Schindler R, Knorr L, Müller C, Heller G Jr, Stork TV, Frei U: Prognostic value of cardiac troponin T and I elevations in renal disease patients without acute coronary syndromes: a 9-month outcome analysis. Nephrol Dial Transplant 1999;14:1489–1495.
  16. Roppolo LP, Fitzgerald R, Dillow J, Ziegler T, Rice M, Maisel A: A comparison of troponin T and troponin I as predictors of cardiac events in patients undergoing chronic dialysis at a Veteran’s Hospital: a pilot study. J Am Coll Cardiol 1999;34:448–454.
  17. Apple FS, Sharkey SW, Hoeft P, Skeate R, Voss E, Dahlmeier BA, Preese LM: Prognostic value of serum cardiac troponin T and I in chronic dialysis patients: a 1-year outcomes analysis. Am J Kidney Dis 1997;29:399–403.
  18. Wu TT, Yuan A, Chen CY, Chen WJ, Luh KT, Kuo SH, Lin FY, Yang PC: Cardiac troponin I levels are a risk factor for mortality and multiple organ failure in noncardiac critically ill patients and have an additive effect to the APACHE II score in outcome prediction. Shock 2004;22:95–101.
  19. Mehta NJ, Khan IA, Gupta V, Jani K, Gowda RM, Smith PR: Cardiac troponin I predicts myocardial dysfunction and adverse outcome in septic shock. Int J Cardiol 2004;95:13–17.
  20. Whiting P, Rutjes AW, Reitsma JB, Glas AS, Bossuyt PM, Kleijnen J: Sources of variation and bias in studies of diagnostic accuracy: a systematic review. Ann Intern Med 2004;140:189–202.
  21. Ferguson JL, Beckett GJ, Stoddart M, Walker SW, Fox KA: Myocardial infarction redefined: the new ACC/ESC definition, based on cardiac troponin, increases the apparent incidence of infarction. Heart 2002;88:343–347.
  22. Fransen EJ, Diris JH, Maessen JG, Hermens WT, van Dieijen-Visser MP: Evaluation of ‘new’ cardiac markers for ruling out myocardial infarction after coronary artery bypass grafting. Chest 2002;122:1316–1321.
  23. Bonnefoy E, Filley S, Kirkorian G, Guidollet J, Roriz R, Robin J, Touboul P: Troponin I, troponin T, or creatine kinase-MB to detect perioperative myocardial damage after coronary artery bypass surgery. Chest 1998;114:482–486.
  24. Sackett DL, Haynes BR, Guyatt GH, Tugwell P: Clinical Epidemiology: A Basic Science for Clinical Medicine, ed 2. Boston, Little, Brown, 1991, pp 117–119.
  25. Sackett DL, Haynes BR, Guyatt GH, Tugwell P: Clinical Epidemiology: A Basic Science for Clinical Medicine, ed 2. Boston, Little, Brown, 1991, pp 120–139.
  26. Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR: A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996;49:1373–1379.
  27. deFilippi C, Wasserman S, Rosanio S, Tiblier E, Sperger H, Tocchi M, Christenson R, Uretsky B, Smiley M, Gold J, Muniz H, Badalamenti J, Herzog C, Henrich W: Cardiac troponin T and C-reactive protein for predicting prognosis, coronary atherosclerosis, and cardiomyopathy in patients undergoing long-term hemodialysis. JAMA 2003;290:353–359.
  28. Bostom AG, Shemin D, Verhoef P, Nadeau MR, Jacques PF, Selhub J, Dworkin L, Rosenberg IH: Elevated fasting total plasma homocysteine levels and cardiovascular disease outcomes in maintenance dialysis patients: a prospective study. Arterioscler Thromb Vasc Biol 1997;17:2554–2558.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50