LEVEL OF HIGH SENSITIVITY TROPONIN I AND IT'S CORRELATION WITH HAEMODIALYSIS VINTAGE IN PATIENTS WITH ESRD – A PILOT STUDY

Introduction:

Renal replacement therapy (RRT) is advised in end-stage renal disease (ESRD), the last stage of chronic kidney disease (CKD). RRT includes Maintenance Hemodialysis (MHD) / Peritoneal dialysis (PD) / Renal Transplant. The requirement for MHD is annually escalating in India. It is important to note that over 80% of patients receiving MHD have at least one cardiac disease at the time of dialysis initiation, such as ischemic heart disease (IHD), congestive cardiac failure (CCF), arrhythmias, etc. The present study aimed to study high-sensitivity cardiac Troponin I (hs-cTnI) serum level as a marker of cardiovascular injury in patients receiving MHD. It was an attempt to envisage a correlation between serum hs-cTnI and Hemodialysis (HD) vintage (duration since initiation of dialysis till date).

Methods:

It was a cross-sectional pilot study conducted from October 2021 to March 2023 in the Department of Biochemistry in collaboration with the Department of Nephrology at a tertiary care teaching hospital in North India. The patients were divided into two groups- Group 1: Those who had received MHD for less than or equal to 24 months. Group 2: Those who had received MHD for more than 24 months. This being a pilot study, a sample size of 40 was taken. A sequential enrolment of the study participants was done till the achievement of sample size. The patients,18 years or older, who were enrolled in the institute's MHD program and provided consent were recruited in the study.  Patients younger than 18 years of age or having any documentary evidence of acute myocardial infarction or heart failure during the past six months were excluded from the study. A thorough medical history and examination were conducted for all study participants. Relevant demographic and clinical parameters were noted. In a plain vial, 2 ml of blood was collected before and after the MHD session after obtaining informed consent. The data was entered into an Excel spreadsheet and checked for errors. It was analyzed using IBM SPSS Statistics version 23, SPSS South Asia Pvt Limited, Bangalore, India.

Results:

Forty subjects (thirty-two males and eight females; mean age 46.25 ± 17.34 years) receiving maintenance haemodialysis were enrolled. The clinical characteristics and demographic features of the two groups depending on the dialysis vintage (those who have received MHD for less than or equal to 24 months and for more than 24 months) are presented in Table 1. Most patients (n= 34, 85%) received MHD for an average of 4 hours per session. Only 6 (15 %) patients received MHD for an average of 6 hours per session. The patients' mean pre- and post-HD serum hs-cTnI levels were 71.85 ±324.08 ng/ml and 95.78 ± 329.52 ng/ml. The correlation of pre-HD and post-HD serum hs-cTnI levels with the duration of HD was not statistically significant. The serum hs-cTnI levels were raised in 34 out of 40 patients post-HD, and the result was statistically significant (p-value = 0.0001).

Conclusions:

The present study has encouraging results, with values of hs-cTnI raised in post-dialysis samples; however, the levels did not correlate with HD vintage. Further studies with larger sample sizes and longer follow-ups would provide more detailed information on hs-cTnI's role as a marker for HD-induced cardiac damage.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.