Role of Troponin-I level in patients with chronic kidney disease (CKD) and diagnosis suspected acute coronary syndrome

Patients with chronic kidney disease (CKD) have a high prevalence of elevated serum troponin levels, which makes diagnosis of acute coronary syndrome (ACS) challenging. This study aimed to evaluate the utility of troponin in ACS diagnosis, treatment, and prognosis among patients with CKD. The literature review presents the studies that reported the efficacy of serum Troponin-I level in diagnosis of acute coronary syndrome in patients with chronic kidney disease between 1980 and 2016 and the search was conducted using the databases PubMed, Medline, EMBASE and Web of Science. We also searched Clinical Trials.gov and requested relevant published or unpublished trials from manufacturers of troponin assays. Myocardial infarction (MI) is a common cause of mortality in patients with chronic kidney disease (CKD). Since the troponin-I level arises in 4-21% and troponin-T in 17-75% of CKD patients without any myocardial cause, diagnostic value of cardiac troponins decreased in these patients. Patients with CKD often have persistently elevated troponin levels reducing the specificity of this test. The reason for the increased levels probably has more to do with increased enzyme release from structural heart disease rather than the more conventional definition of decreased clearance. In one study looking at the half-life of troponin-I following AMI, found no difference between patients with ESRD and patients with normal renal function. Patients with chronic kidney disease (CKD) have a high prevalence of elevated serum troponin levels, which makes diagnosis of acute coronary syndrome (ACS) challenging. Patients with renal insufficiency may have increased serum troponins even in the absence of clinically suspected acute myocardial ischemia, while cardiovascular disease is the most common cause of death in patients with renal failure, we are just beginning to understand the clinical meaning of serum of troponin elevations. Many large-scale trials demonstrating the utility of serum troponins in predicting adverse events. Cardiac troponin-I measured, using the mentioned laboratory method was not suitable to diagnose ACS in CKD patients, therefore, we suggest that CK-MB in similar conditions. More evaluations are needed to approve these findings. In patients with CKD and suspected ACS, troponin levels can aid in identifying those with a poor prognosis.

کلیدواژه ها:

Troponin-I ، Chronic kidney disease (CKD) ، Diagnosis ، Coronary syndrome