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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

High sensitive troponin concentration stability in dialysate of anuric patients on hemodialysis

Abstract

Background. High sensitive troponin I (hsTnI) and high sensitive troponin T (hsTnT) are markers of cardiac damage. Cardiomyocyte necrosis increases its blood levels. It is known that dialysis is cardiotoxic and that results in lack of contractility of certain myocardial segments. This mechanism is primarily due to hypo perfusion of the myocardium during dialysis. The dialysis itself increases cardiovascular (CV) risk in patients by many different mechanisms. It has been proven that the incidence of heart failure is much more frequent in patients on hemodialysis than in healthy population.

The aim of this pilot study was to investigate the presence of troponin T molecules and troponin I in dialysate and compare their concentrations.

Materials and Methods. The study included 5 anuric patients (4M) on hemodialysis. The dialysate samples were sampled for each patient three times during a dialysis cycle. The first sample was taken after thirty minutes, the second sample was taken in the middle of dialysis (120 minutes) and the third sample was taken thirty minutes before the end of dialysis. The value of hsTnI was measured using a high-sensitivity test on the Immuno-enzymatic analyzer Abbott Architest i1000SR. According to CLSI EP15-A2 protocol verification of hsTnT chemiluminescent micro-particle immunoassay on the analytical platform Roche cobas e411 was performed.

Results. Altogether 15 samples (three for each patient) were processed. hsTnT was detected in all 15 samples (13.42 ± 1.18 ng / L), while hsTnI was detected in only 8 samples (0.14 ± 0.16 ng / L). To test the difference in detectability between hsTnT and hsTnI, chi square test was used and the difference was statistically significant (Yates chi-square 6.708, p = 0.009).

Conclusion. The presence of troponin molecules in dialysate was determined for the first time in scientific literature. This study has confirmed that TnT is present in all dialysate samples and that its concentration is stable in dialysate. TnI concentrations were detectable in significantly lower concentrations.

Key words: hemodialysis, hs troponin T, hs troponin I, dialysate

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Refractory ventricular fibrillation with prolonged resuscitation in dialysis-sensitive dysrhythmic patient

Abstract

Sudden cardiac death is a leading cause of death in chronic renal failure patients. We present a case of refractory ventricular fibrillation with successful prolonged resuscitation (> 1 hour) without neurological sequel in an outpatient dialysis centre. Implantation of a cardioverter-defibrillator is able to identify patients as dialysis-sensitive. Smoother potassium removal during hemodialysis could eliminate dysrhythmias. Prehospital (point-of-care) blood gas analysis can be helpful especially in prolonged resuscitation.

 

Keywords: successful resuscitation, ventricular fibrillation, point-of-care, blood gas analysis, potassium, hemodialysis, ICD

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