CARDIAC TROPONIN-T IS ELEVATED IN ASYMPTOMATIC PATIENTS WITH CHRONIC-RENAL-FAILURE

Patients with chronic renal failure (CRF) are at increased risk for my ocardial events that are difficult to evaluate due to atypical symptom s and chronically elevated protein markers of cardiac damage. This stu dy evaluated cardiac troponin T (cTnT), a sensitive marker of cardiac injury, in patients with CRF without myocardial infarction symptoms, a nd assessed potential causes for elevated cTnT. Blood was obtained fro m 38 patients with CRF immediately before hemodialysis and from 16 of them post-dialysis, from 21 peritoneal dialysis patients, 10 patients with CRF not on dialysis, 11 patients with cardiomyopathy, and 10 adol escent patients with CRF undergoing hemodialysis. Samples were analyze d for myoglobin, creatine kinase, creatine kinase isoenzyme-MB (CK-MB) , lactate dehydrogenase, lactate dehydrogenase isoenzyme-1 (LD-1), and cTnT. Cardiac TnT was elevated in: 71% of patient with CRF undergoing hemodialysis with no significant differences between pre- and post-di alysis values, 57% of patients with CRF on peritoneal dialysis, 30% of patients with CRF without dialysis, 18% of patients with cardiomyopat hy, and 20% of adolescent patients with CRF undergoing hemodialysis. M yoglobin was elevated in almost all patients with CRP undergoing hemod ialysis and without dialysis, whereas CK-MB and LD-1 were rarely eleva ted. Cross-reacting dialyzable substances and myocardial stretch were not major causes for elevated cTnT. Until future studies clarify tile etiology of elevated cTnT in patients with CRF, results should be inte rpreted cautiously.