Myocardial markers are highly altered by higher rates of fluid removal during hemodialysis

• Published in: Hemodialysis international Vol. 28; no. 1; pp. 17 - 23
• Main Authors: Goto, Junko, Ott, Michael, Stegmayr, Bernd
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.01.2024
• Subjects: biocompatibility; embolies; heart; hemodialysis; Humans; interdialytic weight gain; Kidney Failure, Chronic - therapy; Renal Dialysis; Troponin T; Ultrafiltration; Weight Gain; hemodialysis; biocompatibility; interdialytic weight gain; heart; embolies
• ISSN: 1492-7535; 1542-4758; 1542-4758
• DOI: 10.1111/hdi.13124

Introduction Although hemodialysis is lifesaving in patients with kidney failure extensive interdialytic weight gain (IDWG) between dialyses worsens the prognosis. We recently showed a strong correlation between IDWG and predialytic values of cardiac markers. The aim of the present study was to evaluate if the cardiac markers N‐terminal pro‐B‐type natriuretic peptide (proBNP) and troponin T were influenced by IDWG and speed of fluid removal (ultrafiltration‐rate). Methods Twenty hemodialysis patients performed in total 60 hemodialysis (three each). Predialytic values of proBNP and troponin T and changes from predialysis to 180 min hemodialysis (180–0 min) were compared with the IDWG calculated in percent of body weight. The ultrafiltration‐rate was adjusted (UF‐rateadj) to IDWG: (100 × weight gain between dialysis [kg])/(estimated body dry weight [kg] × length of hemodialysis session [hours]). Results UF‐rateadj correlated (Spearman) with (1) predialytic values of IDWG (r = 0.983, p < 0.001), proBNP (r = 0.443, p < 0.001), and troponin T (r = 0.296, p = 0.025); and (2) differences in proBNP180–0min (r = 0.572, p < 0.001) and troponin T180–0min (r = 0.400, p = 0.002). UF‐ratesadj above a breakpoint of 0.60 caused more release of proBNP180–0min (p = 0.027). Remaining variables in multiple regression analysis with ProBNP180–0min as dependent factor were predialytic proBNP (p < 0.001) and the ultrafiltration‐rate (p < 0.001). Conclusion Higher UF‐rateadj during dialysis was correlated to increased levels of cardiac markers. Data support a UF‐rateadj lower than 0.6 to limit such increase. Further studies may confirm if limited fluid intake and a lower UF‐rateadj should be recommended to prevent cardiac injury during dialysis.