Abstract: FR-PO130

Serum Troponin-T Levels and Intensity of Pulmonary Liquid Removal Can Indicate Myocardial Injury during Intermittent Hemodialysis Session in Patients with AKI

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Lussim, Lygia, School of Medical Sciences of the University of Campinas, Campinas, Brazil
  • Martins, Fernanda De souza, School of Medical Sciences of the University of Campinas, Campinas, Brazil
  • Brianez, Carolina, School of Medical Sciences of the University of Campinas, Campinas, Brazil
  • Ribeiro, Isabella C, School of Medical Sciences of the University of Campinas, Campinas, Brazil
  • Carvalho filho, Marco antonio De, School of Medical Sciences of the University of Campinas, Campinas, Brazil
  • Santos, Thiago, School of Medical Sciences of the University of Campinas, Campinas, Brazil
  • de Oliveira, Rodrigo B., School of Medical Sciences of the University of Campinas, Campinas, Brazil
Background

Intermittent hemodialysis (IHD) is a modality of renal replacement therapy used in critical patients with acute kidney injury (AKI), in which one of the most common complications is hemodynamic instability, assessed either by clinical, laboratory and point of care ultrasound parameters (POCUS). In this clinical study we evaluated the relationship between serum high sensitivity cardiac troponin-T levels (hs-cTnT) and clinical, POCUS and laboratorial parameters in critical ill patients with AKI over IHD session.

Methods

Clinical and observational study where critical ill patients with AKI were submitted to IHD sessions. Every hour over IHD session we evaluated POCUS parameters [inferior vena cava diameter (IVC) and distensibility (dIVC), extravascular lung water (SLESS score)], mean arterial blood pressure (ABP), heart rate, vasopressors dose, hs-cTnT (reference range: < 14 ng/L), lactate, bicarbonate levels and venous and arterial oxygen saturation.

Results

Six patients (mean SOFA and APACHE II scores of 13±4 and 25±4, respectively), four men (66%), aged 45±15 years, with AKIN III [3 (50%) due to sepsis] were enrolled during 11 IHD sessions. Urea reduction ratio (URR) and ultrafiltration rate (UF) were 43±12 % and 5.1±2.3 mL/kg/h, respectively. At the end of IHD sessions a significant increase of hs-cTnT was detected (186±157 vs. 229±195 ng/L; p=0.02). The magnitude of this variation was not correlated with hemodynamic instability, ABP variation, heart rate, vasopressors dose, UF, POCUS parameters or serum lactate levels. In contrast, a positive correlation was detected between the increase of hs-cTnT and the decrease of SLESS score variation (R=0.74; p=0.02), suggesting impairment of fluid removal from lungs.

Conclusion

Serum hs-cTnT levels as well as the range of variation of pulmonary fluid removal may signal worsening of myocardial injury in critically ill patients with severe AKI and under IHD.

Funding

  • Private Foundation Support