Predictive value of cardiac troponin-T and C-reactive protein in hemodialysis patients

ABSTRACT

Accelerated atherosclerosis is associated with hemodialysis, and more than one half of death in dialysis patients is of cardiovascular etiology. The correlation between serum levels of cardiac troponin-T [cTn-T] and C-reactive protein [CRP], as predictors of cardiac damage and mortality, as well as relationship with some other biochemical parameters were analyzed in hemodialysis patients. The study included 45 chronic renal failure [CRF] patients on regular hemodialysis [HD]. Patients are classified into three groups according to serum levels of cTn-T and CRP; Group I [n = 14], patients with level of cTn-T < 0.1 ng/ml and CRP <10 ng/ml [negative cTn-T and CRP]; Group II [n = 11], patients with level of cTn-T >/= 0.1 ng/ml and CRP >/= 10 ng/ml [positive cTn-T and CRP] and Group III [n = 20], patients with only positive cTn-T or positive CRP. A group of 15 healthy age matched subjects was included for comparison [Group IV]. Moreover, Patients are classified into two groups according to survival [n=35] and non-survival [n=10]. Sera of all subjects were analyzed for cTn-T, CRP, malondialdehyde [MDA], blood urea nitrogen [BUN], creatinine, albumin, hemoglobin [Hb], fibrinogen, total cholesterol, HDL-cholesterol and triacylglycerols. In comparison to control group, cTn-T level was highly significant increase [p<0.001] in all patient groups. While, CRP level showed a highly significant increase [p<0.001] in group II, significant increase [p<0.05] in group III and non significant difference in group I. All other estimated parameters were significantly changed in all studied groups except total cholesterol and HDL-cholesterol. Comparing the results obtained between survivors and non-survivors groups showed a significant difference in the levels of cTn-T, CRP, MDA, BUN, Albumin and fibrinogen. Correlation analyses showed a significant positive correlation between cTn-T and CRP, MDA and fibrinogen and between CRP and MDA, fibrinogen and triacylglycerols in survivors and non-survivors groups. In conclusion, the main finding of the current study was that, the elevated levels of cTn-T and CRP and its correlation may be used as useful risk markers in hemodialysis patients without myocardial infarction