The Influence of Regular Hemodialysis on the Highly Sensitive Troponin-I Level in Children without Any Symptoms

Abstract

Backgrounds: Cardiovascular diseases are still the prominent cause of death in cases of end-stage renal disease, cardiac troponin I (cTnI) can be used for detecting cardiac involvement in asymptomatic cases of end-stage renal disease on hemodialysis. Aim: Determine the direct cardiac consequence of dialysis treatments in children on hemodialysis by measuring high-sensitive troponin-I as a marker of myocardial injury. Subjects and Methods: This case-control study included thirty children with end-stage renal disease on regular hemodialysis; the study group was selected from the nephrology hemodialysis unit of Al-Zahraa Hospital, Al-Azhar University. Another group of thirty healthy children matches age and sex with the patient’s group as a control. Highly Sensitive cTnI (hsTnI) was measured pre and post hemodialysis with a sensitive assay; moreover, ECG, lipid profile including cholesterol, triglyceride, low and high-density lipoprotein (HDL) in the same line with routine investigations for those patients, we used bioimpedance for dry weight assessment in the hemodialysis (HD) group. Results: Children on (HD) have a significantly higher (hsTnI) pre-dialysis (0.250 ± 0.069 ng/ml) compared to post-dialysis (0.187 ± 0.004 ng/ml) with (p, 0.001). With no significant difference between post HD (0.187 ± 0.004 ng/ml) and the control group (0.189 ± 0.005) with (p, 0.090). cTnI is detected in (73.3%) of children pre-dialysis above the cut-off value compared to (3.31%) had a high-level post-dialysis. cTnI is positively correlated with systolic, diastolic blood pressure and heart rate with (r. 0.333, p, 0.001: r. 0.343, p, 0.001: r. 0.276, p, 0.033) respectively and (hsTnI) is negatively correlated with Hb and HDL (r. -0.333, p, 0.009: r. 0.324, p, 0.011). Meanwhile (hsTnI) is positively correlated with serum urea, creatinine, ph, PTH, serum ferritin and positively correlated with QT interval and QTC. Conclusion: cTnI levels rise significantly before hemodialysis, so those patients are exposed to silent myocardial injury pre HD, and fortunately, it is not persistent after hemodialysis except for a few of them had a high level. We strongly advised not to delay dialysis appointments; the nephrology team should aggressively treat those patients to prevent further myocardial damage.