[Troponins and chronic renal failure in dialysis patients].

Cardiovascular disease is a major cause of morbidity and mortality in dialysed patients with chronic renal failure. The diagnostic and prognostic value of cardiac troponin T (TnTc) and I (TnIc) has been questioned in this setting. Dialysed chronic renal failure patients often have raised TnTc and TnIc in the absence of acute ischaemic symptoms. This increase is the consequence of minor myocardial damage due to coronary artery disease, left ventricular hypertrophy and endothelial dysfunction. Abnormal catabolism and differences in the liberation or detection of bound or free forms of the troponins may also contribute to the finding of raised TnTc in asymptomatic chronic renal failure patients. In this population, TnTc has a better prognostic value than TnIc for the identification of patients at greater risk (mortality). Increased TnTc in asymptomatic dialysed chronic renal failure justifies a thorough cardiovascular work-up to diagnose ischaemia, left ventricular hypertrophy (which should be a target for treatment) and left ventricular dysfunction, especially in diabetic renal failure and when non-emergency surgery or renal transplantation are planned. The troponins (mainly TnTc) retain their value for stratification of risk in acute coronary syndromes of patients with renal failure. An invasive strategy and pharmacological treatment (at adapted doses), identical to those considered for patients with normal renal function, should be discussed in dialysis patients with chronic renal failure admitted for acute coronary syndromes with raised troponins.