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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 2  |  Page : 219-222
Assessment of inflammatory factors and cardiac troponin T in hemodialysis patients

Nephrology and Kidney Transplantation Department, Shahid Beheshti Medical University, Taleghani Medical Center, Tehran, Iran

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Hemodialysis (HD) patients suffer from chronic inflammations which make them at increased risk of cardiovascular diseases. The purpose of this study was to see if there is a significant association between inflammatory factors such as ferritin and C-reactive protein (CRP) as well as troponin T in patients on HD. We assessed these serum factors as well as other known cardiac risk factors in 53 patients on HD. The serum ferritin and CRP levels were measured by chemiluminescence's immune assay while troponin T levels were measured by electrochemist luminescence immune assay. We found that serum concentrations of CRP and ferritin were not significantly higher in patients on HD with known cardiac risk factors (compared with the control group) (p< 0.05). However, the serum troponin T levels in HD patients with cardiovascular risk factors were significantly higher than the control group. Our study suggests that elevated serum troponin T levels can play an important role as a predictor of cardiovascular disease in HD patients. Also, inflammatory factors such as CRP and ferritin may be influenced by chronic inflammation or nutritional status of these patients.

Keywords: Hemodialysis, Inflammatory factors, Troponin T, Cardiovascular risk factors

How to cite this article:
Falaknazi K, Bagheri N, Taziki O. Assessment of inflammatory factors and cardiac troponin T in hemodialysis patients. Saudi J Kidney Dis Transpl 2009;20:219-22

How to cite this URL:
Falaknazi K, Bagheri N, Taziki O. Assessment of inflammatory factors and cardiac troponin T in hemodialysis patients. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2021 Jul 27];20:219-22. Available from: https://www.sjkdt.org/text.asp?2009/20/2/219/45525

   Introduction Top

Inflammatory processes are common in indi­viduals with chronic kidney disease (CKD) in the form of chronic renal failure (CRF) or end­stage renal disease (ESRD). This is due to many underlying factors, including an increased inci­dence of infections (most commonly dialysis­access related), the uremic milieu, elevated levels of pro-inflammatory cytokines, frequent presence of widespread arteriosclerosis, and others. Although the definition of inflamma­tion is unclear in this setting, ESRD-associated chronic inflammation as assessed by increased C-reactive protein (CRP)levels has been reported in 30 to 60% of North American and European dialysis patients, with dialysis pa­tients in Asian countries reportedly having a lower prevalence. [1],[2]

The acute phase response is an important pathophysiologic phenomenon that accompa­nies inflammation. [3],[4] It can occur in associa­tion with a wide variety of disorders, including infection, trauma, infarction, inflammatory arth­ritis and various neoplasms. Acute phase pro­tein is defined as those proteins, the plasma concentrations of which increase (positive acute phase protein) or decrease (negative acute phase protein) by at least 25% during infla­mmatory states. [5] These changes largely reflect altered production by hepotocytes. Positive acute phase protein includes ceruloplasmin, CRP, fibrinogen, alpha-1 antitrypsin, hapto­globin and ferritin, while negative reactants in­clude albumin, transferin and transthyretin. A presumed major function of CRP is its ability to bind phosphocholine, thereby permitting recognition of foreign pathogens and phos­pholipid constituents of damaged cell. [6] When thus bound, CRP may activate the complement system and/or bind to phagocyte cells, sugges­ting that it can initiate elimination of target cells by interaction with both humoral and cel­lular effector systems of inflammation. 7 Among patients with CKD, the presence of an in­flammatory state may also be closely related to accelerated atherogenesis, protein-energy mal­nutrition (PEM), and anemia. [8],[9]

Based on this evidence, protein markers of inflammation have been studied as non-inva­sive indicators of underlying atherosclerosis in apparently healthy individuals and of the risk of recurrent events in patients with established atherosclerotic vascular disease. The most extensively studied biomarker of inflammation in cardiovascular disease is CRP, for which standardized high-sensitivity assays are widely available. [3],[4]

Patients with chronic renal failure suffer from chronic inflammation. They are at increased risk of cardiovascular disease. The purpose of this study was to see if there is a significant association between pro-inflammatory factors and troponin T in hemodialysis (HD) patients.

   Patients and Methods Top

A total of 53 consecutive patients on regular HD were studied of whom 25 patients were non-diabetic and had major risk factors for coronary artery disease (CAD). Twenty-eight other patients of the same gender, age-group and duration on HD, but without risk factors for CAD were considered as control groups.

Major risk factors for CAD included presence of cardiovascular disease in a first-degree re­lative including myocardial infarction, conges­tive heart failure or history of coronary revas­cularization, diabetes mellitus, smoking and/or hypertension.

Blood samples for CRP, ferritin, troponin T and albumin levels were measured before the beginning of mid-week HD session. Ferritin and troponin T were measured by electroche­mist luminescence immune assay, CRP by nephlometry and albumin by autoanalyzer (Pars azmoon Kit) (CV< 0.1).

Statistical analyses of all data were done by SPSS V.13 and ANOVA. Clinical variables are reported as median and/or as mean and SD. Two sided p values less than 0.05 were con­sidered statistically significant.

   Results Top

We studied the inflammatory markers and troponin T in 25 patients on HD with major risk factors for CAD (study group) and 28 other HD patients without major risk factors for CAD (control group). The demographic and biochemical characteristics of the study population are shown in [Table 1]. We found that patients in Group 1 (case group) had higher CRP (19.5 ± 5 vs 8.3 ± 5) and troponin T (0.08 ± 0.03 vs. 0.03 ± 0.001) levels than the control group (p< 0.05). There was no signifi­cant difference between the two groups in terms of serum ferritin and serum albumin levels.

   Discussion Top

Our study showed that there was no signi­ficant difference in the erythrocyte sedimen­tation rate (ESR) as well as serum levels of ferritin and albumin between the two groups of patients; however, the serum troponin T and CRP levels were higher in patients who had one or more major risk factors for CAD, which is compatible with the results of Zumrutdal A et al. [10] Wong, in his report, indicated that se­rum pro-inflammatory factors like CRP and troponin T, were significantly higher in HD patients. [11] Spiegel et al, in their study, de­monstrated that low albumin and high CRP were the strongest predictors of mortality in HD patients. [12] However, in our study the serum albumin levels were not significantly different between the two groups, probably due to malnutrition in our patients. Most of our patients had low serum creatinine levels and low body mass index (BMI) (BMI mean = 18.2 ± 3.1).

We found that the serum ferritin levels and ESR were similar in the two groups. These markers could suggest the presence of infla­mmation such as gingivitis and access infec­tion. Chronic inflammation may be a principal factor that causally links protein- energy mal­nutrition to increased morbidity and mortality among dialysis patients. The term malnutrition­inflammation suggests the purported close association between protein-energy malnutri­tion and inflammation in dialysis patients. [9],[13],[14]

Alternatively, the term "malnutrition-inflam­mation- atherosclerosis" (MIA) has been used to also emphasize the importance of athero­sclerotic disease as a major consequence of the syndrome. [15]

   Conclusion Top

Our study suggests that elevated cardiac tro­ponin T and CRP levels identified patients with CAD and as such, this test should be incor­porated in routine diagnostic evaluation of pa­tients on HD to facilitate early detection and management of clinically silent, but high risk coronary artery disease.

   References Top

1.Yeun JY, Levine RA, Mantadilok V, Kaysen GA. C-reactive protein predicts all-cause and cardiovascular mortality in hemodialysis pa­tients. Am J Kidney Dis 2000;35(3):469-76.  Back to cited text no. 1    
2.Kalantar-Zadeh K. Recent advances in unders­tanding the malnutrition-inflammation-cachexia syndrome in chronic kidney disease patients: What is next? Semin Dial 2005;18(5):365-9.  Back to cited text no. 2    
3.Kushner, I. The phenomenon of the acute phase response. Ann N Y Acad Sci 1982; 389:39-48.  Back to cited text no. 3    
4.Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999;340(6):448-54.  Back to cited text no. 4    
5.Morley JJ, Kushner I. Serum C-reactive protein levels in disease. Ann N Y Acad Sci 1982; 389:406-18.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Volanakis JE. Acute phase proteins in rheu­matic disease. In: Arthritis and Allied Condi­tions: A Textbook of Rheumatology, Koopman, WJ (Ed) Williams Wilkins, Baltimore 1997. p.505.  Back to cited text no. 6    
7.Hoffmann JA, Kafatos FC, Janeway CA, Ezekowitz RA. Phylogenetic perspectives in innate immunity. Science 1999;284(5418):1313-8.  Back to cited text no. 7    
8.Qureshi AR, Alvestrand A, Divino-Filho JC, et al. Inflammation, malnutrition, and cardiac disease as predictors of mortality in hemo­dialysis patients. J Am Soc Nephrol 2002;13 Suppl 1:S28.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]
9.Kalantar-Zadeh K, Kopple JD. Relative contri­butions of nutrition and inflammation to clinical outcome in dialysis patients. Am J Kidney Dis 2001;38(6):1343-50.  Back to cited text no. 9    
10.Zumrutdal A, Baltali M, Micozkadiglu H, et al. Determinants of coronary artery disease in nondiabetic hemodialysis patients: A matched case-control study. Ren Fail 2007;29(1):67-71.  Back to cited text no. 10    
11.Wong CK, Szeto CC, Chan MH, et al. Ele­vation of pro inflammatory cytokines, C­reactive protein and cardiac troponin T in chronic renal failure patients on dialysis. Immunol Invest 2007;36(36):47-57.  Back to cited text no. 11    
12.Spiegel DM, Raggi P, Smits G, Block GA. Factors associated with mortality in patients new to hemodialysis. Nephrol Dial Transplant 2007;22(12):3568-72.  Back to cited text no. 12    
13.Kalantar-Zadeh K, Kopple JD, Block G, Humphreys MH. A malnutrition-inflammation score is correlated with morbidity and mor­tality in maintenance hemodialysis patients. Am J Kidney Dis 2001;38(6):1251-63.  Back to cited text no. 13    
14.Kalantar-Zadeh K, Ikizler TA, Block G, Avram MM. Malnutrition-inflammation complex syn­drome in dialysis patients: Causes and consequences. Am J Kidney Dis 2003;42(5): 864-81.  Back to cited text no. 14    
15.Stenvinkel P, Heimburger O, Lindholm B, Kaysen GA, Bergstrom J. Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnu­trition, inflammation and atherosclerosis (MIA syndrome). Nephrol Dial Transplant 2000; 15(7):953-60.  Back to cited text no. 15    

Correspondence Address:
Nazila Bagheri
Taleghani Hospital, Velenjak Avenue, P. O. Box 1985 711151, Tehran
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PMID: 19237807

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