High-sensitive cardiac troponin-I levels in asymptomatic haemodialysis patients

Background: High-sensitivity cardiac troponin (hs-cTn) aids in early acute myocardial infarction detection, but chronic haemodialysis patients usually have higher baseline levels, often exceeding the upper reference limit (URL), The aim of the current study was to identify the URL values of hs-cTnI in asymptomatic hemodialysis patients, examine the impact of hemodialysis on hs-cTnI levels, and evaluate the association between hs-cTnI levels and mortality and hospitalization.

Methods: A prospective single-center observational cohort study was performed in a tertiary care center between August 2023 and July 2024. Blood samples for hs-cTnI levels were collected from asymptomatic haemodialysis patients aged ≥40. Hs-cTnI levels were measured before and after dialysis, and patients were followed-up for up to 12 months.

Results: Fifty-six haemodialysis patients were enrolled. The mean hs-cTnI levels pre- and post-dialysis were 28.4 (±32) ng/L and 27.9 (±30) ng/L, respectively. Hs-cTnI levels ranges for pre- and post-dialysis were <6-223 ng/L (± 29) and <6-187 ng/L (± 26.7), respectively. The mean hs-cTnI delta between pre- vs. post-dialysis was 0.5 (±11.63) ng/L with a range of (-12) – 36 ng/L (minus twelve to thirty-six). Twenty-nine (52%) patients had a positive hs-cTnI delta, while 17 (30%) had no hs-cTnI delta and 10 (18%) had negative hs-cTnI delta (i.e. increase hs-cTnI) post dialysis. During the follow-up period, no association was found between baseline hs-cTnI levels and mortality or hospitalizations.

Conclusion: Most asymptomatic hemodialysis patients have baseline hs-cTnI levels within the "grey zone," with no significant change in hs-cTnI levels observed after dialysis. Additionally, no association was found between elevated baseline hs-cTnI levels and mortality or hospitalization.