Department of Clinical Biochemistry and Immunology, University Hospital of Southern Denmark, Aabenraa, Denmark.
Department of Clinical Biochemistry and Immunology, Lillebaelt Hospital, Vejle, Denmark.
Semin Dial. 2024 Mar-Apr;37(2):110-116. doi: 10.1111/sdi.13178. Epub 2023 Oct 1.
Patients with end-stage renal disease (ESRD) have an increased risk of cardiovascular disease, but interpreting cardiac troponin is difficult in this population. The effect of renal replacement therapy (RRT) is important to consider when interpreting serial cardiac troponin T (cTnT) results for patients with ESRD suspected of acute coronary syndrome (ACS). The aim of this systematic review is to answer how low-flux hemodialysis (LF-HD), high-flux hemodialysis (HF-HD), and hemodiafiltration (HDF) affect the blood concentration of high-sensitive cardiac troponin T (hs-cTnT).
Several databases were searched and identified records were evaluated independently by two of the authors. Pre- and postdialysis hs-cTnT concentrations together with other relevant data were extracted from the included studies. The quality (potential bias and applicability issues) were assessed for each of the included studies.
The literature search identified 2,540 records and 15 studies were included. The relative pre- to postdialysis change of hs-cTnT varied from -41 to 29%. LF-HD increased the hs-cTnT concentration with relative changes between 2 and 17%. HDF decreased the concentration with relative changes from -41% to -9%. Both increases and decreases were seen for HF-HD (-16% to 12%).
DISCUSSION/CONCLUSION: In this systematic review, we found LF-HD to increase the hs-cTnT concentration and HDF to decrease the concentration. Results for HF-HD and unspecified HD are more heterogeneous. Because of the differences between the included studies, a meta-analysis was not meaningful. This systematic review can help with the assessment of patients with ESRD suspected of ACS in relation to hemodialysis/HDF treatment.
终末期肾病（ESRD）患者心血管疾病风险增加，但在该人群中解读心肌肌钙蛋白较为困难。在解读疑似急性冠状动脉综合征（ACS）的 ESRD 患者的连续心肌肌钙蛋白 T（cTnT）结果时，肾替代治疗（RRT）的效果很重要。本系统评价旨在回答低通量血液透析（LF-HD）、高通量血液透析（HF-HD）和血液透析滤过（HDF）如何影响高敏心肌肌钙蛋白 T（hs-cTnT）的血液浓度。
搜索了多个数据库，并由两位作者独立评估了确定的记录。从纳入的研究中提取了透析前和透析后的 hs-cTnT 浓度以及其他相关数据。对纳入的每项研究的质量（潜在偏倚和适用性问题）进行了评估。
文献检索确定了 2540 条记录，纳入了 15 项研究。hs-cTnT 的相对透析前至透析后变化范围为-41%至 29%。LF-HD 使 hs-cTnT 浓度增加，相对变化在 2%至 17%之间。HDF 降低浓度，相对变化从-41%至-9%。HF-HD 则出现了增加和减少（-16%至 12%）。
讨论/结论：在本系统评价中，我们发现 LF-HD 增加了 hs-cTnT 浓度，HDF 降低了浓度。HF-HD 和未特指 HD 的结果更具异质性。由于纳入研究之间的差异，进行荟萃分析没有意义。本系统评价可以帮助评估疑似 ACS 的 ESRD 患者与血液透析/HDF 治疗相关的情况。
