engleski

PILOT STUDY OF TROPONIN T AND TROPONIN I CONCENTRATION STABILITY IN DIALYSATE OF ANURIC PATIENTS ON HEMODIALYSIS

INTRODUCTION AND AIMS: Troponin (Tn) is a protein molecule that forms an integral part of the muscular cellular contraction mechanism. It consists of three components: troponin T (TnT), troponin I (TnI) and troponin C. The heart has two gene isoforms for TnT and TnI that are specific for heart muscle and these two molecules are used as a marker for cardiac damage detection. Damage affecting the heart muscle is the main source of blood troponin ellevation, but there is no clear elimination pathway of troponin from the blood. We investigated the effect of hemodialysis (HD) on elimination of Tn in anuric patients. The aim of this pilot study is to determine whether Tn levels can be determined in dialysate and whether there is a difference between the Tn concentration in dialysate during HD. METHODS: The study included 5 anuric patients (4M) who were in chronic HD program at CH Merkur. Patients were median age 70 year (MIN 58, MAX 74y), without heart failure. Diabetes had three patients involved in the study. The HD procedure was performed in all patients three times a week for 4h, the ultrafiltration volume of dialysis was 2.2 ± 0.9 liters, depending on the required volume for removal. Bicarbonate dialysate was used. Fresenius FX dialysers membranes were used in 3 patients and Rexed dialysers membrane were used in other 2 patients. Tn level was determined in three dialysate samples for each patient: first sample in 30th min (TnT1, TnI1), second in 120th min (TnT2, TnI2), and third in 180th min HD (TnT3, TnI3). Concentration of hsTnI in dialysate was determined by chemiluminescence immunochemical method on microparticles on the Immuno-enzymatic Analyzer Abbott Architest i1000SR. The concentration of high sensitive troponin T (hsTnT) was determined by the immunochemical method with electrochemiluminiscent detection on a Roche cobas® e411 analyzer using Roche Diagnostics Troponin T high sensitive (TnT-hs) assay. For statistical analysis, Student's T test and Wilcoxon W test were used (intradialysis comparisons of TnT and TnI were performed with the Wilcoxon matched paired test. Interdialysis comparison of TnT and TnI were performed with Student T test.Significance was assumed at values of p <0.05). RESULTS: TnT was detectable in all 15 dialysate samples (100%), while TnI was detectable in 8 of 15 (53.3%). TnT concentrations in dialysate were more than TnI (t = 44.9028, p <0.001). The difference between concentration of TnT in dialysate at the end of dialysis (13.27 ± 0.74ng / L) was not statistically significant compared to the average measured TnT concentration in dialysate (13.42 ± 1.18 ng / L) (p-value = 0.9530). The difference in the concentration of TnI in dialysate at the end of HD (0.16 ± 0.23 ng / L) was not statistically significant compared to the mean TnI concentration in dialysate (0.14 ± 0.16 ng / L) (p-value = 1.0000). The results of Tn analysis are shown in Table 1. CONCLUSIONS: The presence of TnT and TnI was first time proved in the dialysate of anuric patients at HD. Significant differences in the concentration of TnT and TnI in dialysate during HD were not demonstrated. The reason why the TnT concentration is higher than TnI can be explained by binding TnI to the dialysis membrane, which requires additional analyzes on a large number of patients. This pilot study has confirmed for the first time that Tn can be determined in dialysate and that its dialysate concentrations are stable over the entire duration of dialysis.

hemodialysis ; dialysis ; solutions ; troponin t ; troponin i ; mass or substance concentration per volume

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