Cardiac troponin I in patients with chronic kidney disease stage 3 to 5 in conditions other than acute coronary syndrome.

BACKGROUND: Elevations of cardiac troponin I (cTnI) not associated with acute coronary syndrome (ACS) have been reported in patients with chronic kidney disease (CKD) stage 5 or end-stage renal disease (ESRD). The aim of this study was to determine the prevalence of elevated cTnI in patients with CKD stage 3 to 5 in conditions other than ACS. METHODS: The study population consisted of 426 patients with CKD stage 3 to 5 (estimated glomerular filtration rate < 60 mL/minute/1.73m2 calculated with the MDRD-4 equation) admitted with symptoms of ACS but finally this diagnosis was ruled out with determinations of cTnI and medical history, physical examination, and electrocardiography. Levels of cTnI in serum were measured at admission, at 6 - 12 hours and at 6 months with two different analytical methods (Access and Vidas analyzers). Patients were assigned into the following two groups according to the clinical diagnosis: 1) patients with Other Cardiac Diseases (OCD) and 2) patients with Other Noncardiac Diseases (ONCD). RESULTS: The OCD group included 140 patients (33%) and the ONCD group included 286 patients (67%). We found elevated cTnI (higher than 99th percentile) with the Access and Vidas analyzers in 32% of patients. The prevalence of elevated cTnI was higher in patients with CKD stage 5 or ESRD. In the OCD group, the most common diagnoses were congestive heart failure (52.1%) and atrial fibrillation (20%), whereas in the ONCD group they were arterial hypertension (8.4%) and cerebrovascular accident (8.1%). The rate of mortality in patients with CKD stage 3 to 5 was 17% but was higher in patients with CKD stage 5 (40%). CONCLUSIONS: Elevations of cTnI not associated with ACS were common in patients with CKD stage 3 to 5, and there was an increase in mortality with higher concentrations of cTnI.

Troponina I cardíaca y creatina cinasa MB en pacientes con insuficiencia renal crónica / Cardiac troponin I and creatine kinase MB isoenzyme in patients with chronic renal failure

Objetivo: Evaluar valores de corte (VC) para el diagnóstico del síndrome coronario agudo (SCA) en pacientes con insuficiencia renal crónica (IRC) para los biomarcadores cardíacos troponina I cardíaca (TnIc) y creatina cinasa MB (CK-MB) diferentes a los recomendados por los fabricantes de los reactivos y utilizados habitualmente en los laboratorios. Métodos: Realizamos un estudio prospectivo de pruebas diagnósticas en pacientes con IRC con una tasa de filtración glomerular estimada con la ecuación MDRD4 < 60 ml/min ingresados por sospecha de SCA según la historia clínica, la exploración física y el electrocardiograma. Se evaluó la concentración de TnIc y CK-MB al ingreso hospitalario y a los seis meses, utilizando dos sistemas analíticos diferentes (para TnIc, los analizadores Access® y Vidas®, y para CK-MB, los analizadores Access® y Vitros®). Resultados: Durante el período de estudio, se incluyeron 484 pacientes con IRC y sospecha de SCA. Se diagnosticó SCA en el 12 % de los pacientes (58/484), mientras que se encontraron otras patologías cardíacas en (..) (AU)

Objective: The aim of our study was to evaluate cut-off values for acute the cardiac biomarkers cardiac troponin I (cTnI) and creatine kinase MB isoenzyme (CK-MB) in patients with chronic renal failure (CRF) different to the cut-off values proposed by the manufacturers and frequently used at the laboratory. Method: We performed a prospective study in patients with CRF with a glomerular filtration rate estimated by the MDRD-4 equation <60mL/min admitted with suspected acute coronary syndrome (ACS) by history, physical examination, and electrocardiography. cTnI and CK-MB measurements were assessed at admission and six months later by using two different analytical methods (for cTnI: Access® and Vidas® analysers, and for CK-MB: Access® and Vitros® analysers). Results: During the study period, 484 patients with CRF and suspected ACS were included. ACS was diagnosed in (..) (AU)

Cardiac troponin I and creatine kinase MB isoenzyme in patients with chronic renal failure.

OBJECTIVE: The aim of our study was to evaluate cut-off values for acute coronary syndrome (ACS) diagnosis in patients with chronic renal failure (CRF) for the cardiac biomarkers cardiac troponin I (cTnI) and creatine kinase MB isoenzyme (CK-MB) as compared to the cut-off values proposed by the manufacturers and those frequently used in the laboratory. METHOD: We performed a prospective study in patients with CRF with a glomerular filtration rate estimated by the MDRD-4 equation <60 mL/min and admitted with suspected acute coronary syndrome due to clinical history, physical examination, and electrocardiography. cTnI and CK-MB measurements were assessed upon hospitalisation and six months later using two different analytical methods (for cTnI: Access® and Vidas® analysers, and for CK-MB: Access® and Vitros® analysers). RESULTS: During the study period, 484 patients with CRF and suspected ACS were assessed. ACS was diagnosed in 12% of patients (58/484), while we found other cardiac pathologies (OCP) in 29% of patients (140/484) and other non-cardiac pathologies (ONCP) in 59% of patients (286/484). For cTnI assessed using the Access® analyser with the usual cut-off value (≥ 0.5 ng/mL), sensitivity was 43% and specificity was 94%, while for the proposed cut-off value (≥ 0.11 ng/mL), the values were 68% and 83%, respectively. For cTnI assessed using the Vidas® analyser with the usual cut-off value (≥ 0.11 ng/mL), sensitivity was 64% and specificity was 87%, while for the proposed cut-off value (≥ 0.06 ng/mL), the values were 75% and 79%, respectively. The sensitivity and specificity for both CK-MB were lower compared with cTnI. CONCLUSION: The cut-off values proposed in this study for both cTnI in patients with CRF (stage 3 to 5) to diagnose ACS are significantly different from that of the general population.