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Abstract: SA-PO586

Clearance of Cardiac Troponins Depends on Hemodialysis Mode: A Randomized Cross-Over Trial

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kolland, Michael, Medizinische Universitat Graz, Graz, Austria
  • Amenitsch, Jascha, Medizinische Universitat Graz, Graz, Austria
  • Schreiber, Nikolaus, Medizinische Universitat Graz, Graz, Austria
  • Ginthör, Noemi E., Medizinische Universitat Graz, Graz, Austria
  • Schuller, Max, Medizinische Universitat Graz, Graz, Austria
  • Riedl, Regina, Medizinische Universitat Graz, Graz, Austria
  • Rainer, Peter P., Medizinische Universitat Graz, Graz, Austria
  • Schneditz, Daniel, Medizinische Universitat Graz, Graz, Austria
  • Niedrist, Tobias, Medizinische Universitat Graz, Graz, Steiermark, Austria
  • Eller, Kathrin, Medizinische Universitat Graz, Graz, Austria
  • Krietemeyer, Benedikt, Medizinische Universitat Graz, Graz, Austria
  • Rosenkranz, Alexander R., Medizinische Universitat Graz, Graz, Austria
  • Kirsch, Alexander H., Medizinische Universitat Graz, Graz, Austria
Background

Diagnosis of acute myocardial infarction (AMI) is difficult in hemodialysis (HD) patients as they less likely present typical features, thus, diagnosis relies on biomarkers. There is inconclusive data on cardiac Troponin (cTn) kinetics during HD without considering membrane characteristics.

Methods

We included prevalent, clinically stable HD patients and measured cTns (cTnT and cTnI) concentrations before, during and after HD with different modalities (low-flux HD, high-flux HD, hemodiafiltration [HDF] and medium cut-off (MCO)-HD). Treatment characteristics were standardized and similar between groups. The primary aim was to compare relative changes of cTns from baseline to after 1 hour of HD (Δ1h) for different dialysis modalities with secondary outcomes including absolute and relative changes of cTns during and after HD, using linear mixed models accounting for subjects, sequence, period and treatment.

Results

Of 20 patients, one patient was excluded because of NSTE-AMI, thus, 19 were included in final analysis. Of those 47.4 % were female (mean age 65.5±13.4 years, median dialysis vintage 19 months (min. 3, max. 165)). Different Δ1h were observed for MCO (least square mean [LSM] -21.9 ± 2.7%) vs. low-flux (+2.2 ± 2.7%, p<0.001) and MCO vs. high-flux (LSM -6.8 ± 2.7%, p<0.001) with no difference for MCO vs. HDF (LSM -21.2± 2.7%, p=0.81). Similar results were observed post HD. For absolute changes, LSM for MCO were -21.2 (± 3.2 pg/mL), -6.4 (± 3.2 pg/mL) for high-flux, -20.2 (± 3.2 pg/mL) for HDF treatment and +2.3 (± 3.2 pg/mL) for low-flux HD after one hour. There was no clear trend in cTnI kinetics.

Conclusion

Standard diagnostic AMI algorithms cannot be applied during HD. A Δ of >20% of cTnT, recommended by the SONG-HD MI group, occurs without evidence of ACS when MCO-HD or HDF are applied.