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A Clinical Study on Troponin Ⅰ Concentration in Patients with Chronic Kidney Disease

Author: GaoYongNing
Tutor: GaoZhiYing
School: Hebei Medical University
Course: Internal Medicine
Keywords: serum troponin I chronic kidney disease acute acutecoronary artery disease hemodialysis left ventricular mass index(LVMI) high sensitivity C-reactive protein(hsCRP)
CLC: R692
Type: Master's thesis
Year: 2012
Downloads: 67
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Abstract


Objective:To evaluate cTnI concentration in patients with chronickidney disease(CKD), treated conservatively or with hemodialysis, withhealthy controls, and to explore the cardiovascular risk factor profile in thesegroups.Methods:Subjects in this clinical study excluded people who wereyounger than18years of age, who were made a definite diagnosis of DiabetesMellitus, coronary heart disease and heart failure, and who had acute infectionin two weeks. The study population consisted of six Groups: Group I (n=10,5women,5men, mean age (32.0±4.5years)-healthy, young volunteers withoutkidney diseases with creatinine clearance (Ccr)96.28±22.60ml/min; GroupII (n=20,10women,10men, mean age45.0±16.8years)-patients with CKDin stages3-5with Ccr=35.42±17.64ml/min, treated conservatively, butwithout acute coronary syndrome; and Group Ⅲ (n=31,15women,16men,mean age50.3±16.3years)-patients on long-term hemodialysis without acutecoronary syndrome;mean of total time of dialysis was about180±73; mean ofKt/V was1.51±0.30.1.45±0.29and Group Ⅳ(n=10,4women,6men, meanage58.1±15.2years)-patients with normal renal function and acute coronaryartery disease(ACS); and Group Ⅴ(n=11,4women,7men, mean age54.0±12.1years)-patients with CKD and acute coronary artery disease(ACS); andGroup Ⅵ(n=10,4women,6men, mean age51.5±13.2years)-patients onlong-term hemodialysis with acute coronary artery disease;mean of total timeof dialysis was about176±73weeks;mean of Kt/V was1.51±0.30. Themodel and specification of dialyzer were in no difference in groupⅢ andgroup. The total time of dialysis was nearly same and the frequencies ofdialysis were both3times per week. Acute coronary syndrome was diagnosedby clinical symptoms(Dyspnea and chest pain), elevation of cTnI and CKMB, and manifestation of electrocardiogram in development. The cTnI level wasmeasured using an AxSYM analyzer (Abbott). In group I and group II bloodsamples were collected in the morning after overnight fasting. In group Ⅲblood was taken before the hemodialysis session. In group Ⅳ and group Ⅴand group Ⅵ blood samples were collected during the4thhour and the6thhour after the onset of acute coronary artery disease. The high sensitivityC-reactive protein(hsCRP), hemoglobin, parathyroid hormone (PTH) andphosphorus levels were determined. Blood pressure was recorded.Echocardiography was performed and left ventricular mass index (LVMI) wascalculated on the basis of the Devereux and Reichek formula. These data wereprocessed by SPSS19.0. Metric data (cTnI, LVMI, Phos, Hb, hsCRP, PTH,SBP, DBP) was expressed as average±standard deviation. Means of differentgroups were compared with analysis of variance. Correlations betweenvariables were calculated with correlation analysis and multiple regressionanalysis. P<0.05and P<0.01was statistically different.Results:1. Compared with Group I, the cTnI values were significantly higher inGroup III and Group II (P<0.01, respectively),(0.0020±0.0042ng/ml Vs0.1595±0.0648ng/ml Vs0.2419±0.0801ng/ml), especially in Group III. InGroup II cTnI concentration was over the normal range (0.1ng/ml) in85%ofpatients, and cTnI concentration exceeded the acute myocardial infarctiondiagnostic cut-off (0.2ng/ml) in30%of patients. In Group III cTnIconcentration fell outside of the normal level in all hemodialysed patients, andcTnI concentration exceeded the acute myocardial infarction diagnostic cut-offin68.0%of patients.2. Compared with GroupⅣ, the cTnI values were significantly higher inGroup V and Group VI (P <0.01, respectively),(4.6050±2.80834ng/ml Vs6.5909±1.5957ng/ml Vs8.3260±4.41670ng/ml), especially in Group VI.3. In CKD patients treated conservatively (including Group II andGroup Ⅴ), correlations existed between cTnI concentration and LVMI(P<0.01)(r=0.811), PTH(P<0.01)(r=0.635), hsCRP(P<0.01)(r=0.929), age(P<0.01)(r=0.575), hemoglobin concentration (P<0.01)(r=-0.403) andSBP (P<0.01)(r=0.687). In patients on long-term hemodialysis (includingGroup III and Group Ⅵ), correlations existed between cTnI concentration andLVMI (P<0.01)(r=0.966), PTH(P<0.01)(r=0.639), hsCRP(P<0.01)(r=0.947),age(P<0.01)(r=0.726), hemoglobin concentration (P<0.01)(r=-0.583) andSBP (P<0.01)(r=0.826).Conclusion:1. Chronic kidney disease is associated with increased cTnIconcentration.2. Hemodialysis can lead to elevation of cTnI level in patients withchronic kidney disease.3. There is no consensus on the cutoff of the cTnI level in ESRD patientsthat is of diagnostic utility on acute myocardial infarction.4. Cardiovascular risk factors in chronic kidney disease patients areinvolved with anemia, hypertension,inflammation status,advanced age,volumeoverload, secondary hyperparathyroidism and renin-angiotensin-aldosteronesystem and sympathetic system overactivity.

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