Falsely elevated troponin T but not troponin I in patients with renal impairment
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:71A 1997
The biochemical diagnosis of myocardial injury is often difficult in patients with ESRD because of spurious increases in creatine kinase MB. Recently, the serum levels of the cardiac troponins T and I have been introduced as more sensitive markers of myocardial damage. Previous studies have shown that troponin T may be elevated in up to 50 % of ESRD patients without evidence of acute myocardial injury [1].
In this study troponin T and I concentrations were measured by immunoassays in 85 patients with chronic renal failure (23 predialysis, 20 CAPD and 42 HD pts). Patients with ischemic heart disease, liver disease, tumors and other myopathies than uremic myopathy were excluded. Whereas the specificity of the test for troponin T was 46 % (95 % confidence interval 24-68 %) in long-term HD pts (>1 y), no falsely-positive elevated troponin I levels were found, e.g., specificity was 100 % (85-100 %).
Comment: In accordance with previous studies, the assay for troponin I was found to have a higher specificity than troponin T. The 20-fold difference in cut-off values (0.1 µg/l for troponin T vs. 2.0 µg/l for troponin I) in this study may have influenced the results. Nevertheless, assessment of troponin I promises to be the best available marker of acute myocardial injury in ESRD patients. (Peter F. Barany, M.D., Stockholm, Sweden)
1. Apple FS, Sharkey SW, Hoeft P, Skeate R, Voss E, Dahlmeier BA, Preese LM. Prognostic value of serum cardiac troponin I and t in chronic dialysis patients - a 1-year outcomes analysis. Am J Kidney Dis 1997; 29: 399-403.
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ASN 30th Annual Meeting, San Antonio
CRF by organ system : Cardiovascular/Hypertension