Evolution of high-sensitivity troponin-T and echocardiography parameters in patients undergoing high efficiency on-line hemodiafiltration versus conventional low-flux hemodialysis

Autoři: Isabelle Ethier aff001;  Dominique Auger aff002;  Martin Beaulieu aff003;  Ewa Wesolowska aff003;  Renée Lévesque aff001
Působiště autorů: Department of Nephrology, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada aff001;  Department of Cardiology, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada aff002;  Department of Biochemistry, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223957


Background and objectives

On-line hemodiafiltration (HDF) has been associated with better inflammatory markers profile and survival than low-flux hemodialysis (HD). This study aimed at determining the effect of HDF vs HD on hs-TnT and echocardiography parameters evolution at one year follow-up.


Patients were randomized from 2007 to 2013 to HD or HDF in accordance with the CONvective TRAnsport STudy protocol initially as part of the Montreal cohort and subsequently as part of a local cohort. Pre-dialysis hs-TnT were analyzed at baseline and 1-year follow-up.


A total of 54 HDF patients and 59 HD patients were included. At baseline, median hs-TnT value was 49 ng/L (IQR 31–89) in the HDF group vs. 60 ng/L (36–96) in the HD group (p = 0.370). At one year follow-up, median hs-TnT remained stable in the HDF group (p = 0.707 vs. baseline), but significantly increased to 62 ng/L (40–104) in the HD group (p = 0.021 vs. baseline). The median variation (delta) in hs-TnT values was -3 ng/L (IQR -7-+8) in the HDF group vs. +8 ng/L (-5 -+25) in the HD group (p = 0.042). In the HDF group, LVEF increased from 60.0% (IQR 55.0–65.0) at baseline to 65.0% (60.0–65.5) at 1-year follow-up (p = 0.040) whereas it remained stable in the HD group (LVEF of 60.0% [IQR 55.0–65.0] at baseline and 65.0% [55.0–65.0] at 1-year follow-up [p = 0.312]).


High-efficiency HDF is associated with stability in hs-TnT values, whereas low-flux HD is associated with significant increase in hs-TnT levels.

Klíčová slova:

Biomarkers – Convection – Coronary heart disease – Echocardiography – Chronic kidney disease – Medical dialysis – Troponin – Hemofiltration


1. Foley RN. Clinical epidemiology of cardiovascular disease in chronic kidney disease. J Ren Care. 2010;36(SUPPL. 1):4–8.

2. den Hoedt CH, Bots ML, Grooteman MPC, van der Weerd NC, Mazairac AHA, Penne EL, et al. Online hemodiafiltration reduces systemic inflammation compared to low-flux hemodialysis. Kidney Int. 2014;86:423–32. doi: 10.1038/ki.2014.9 24552852

3. Panichi V, Rizza GM, Paoletti S, Bigazzi R, Aloisi M, Barsotti G, et al. Chronic inflammation and mortality in haemodialysis: Effect of different renal replacement therapies. Results from the RISCAVID study. Nephrol Dial Transplant. 2008;23(7):2337–43. doi: 10.1093/ndt/gfm951 18305316

4. Grooteman MPC, van den Dorpel MA, Bots ML, Penne EL, van der Weerd NC, Mazairac AHA, et al. Effect of Online Hemodiafiltration on All-Cause Mortality and Cardiovascular Outcomes. J Am Soc Nephrol. 2012;23(6):1087–96. doi: 10.1681/ASN.2011121140 22539829

5. Ok E, Asci G, Toz H, Ok ES, Kircelli F, Yilmaz M, et al. Mortality and cardiovascular events in online haemodiafiltration (OL-HDF) compared with high-flux dialysis: Results from the Turkish OL-HDF Study. Nephrol Dial Transplant. 2013;28(1):192–202. doi: 10.1093/ndt/gfs407 23229932

6. Maduell F, Moreso F, Pons M, Ramos R, Mora-Macià J, Carreras J, et al. High-Efficiency Postdilution Online Hemodiafiltration Reduces All-Cause Mortality in Hemodialysis Patients. J Am Soc Nephrol. 2013;24:487–97. doi: 10.1681/ASN.2012080875 23411788

7. Mostovaya IM, Bots ML, van den Dorpel M a., Grooteman MPC, Kamp O, Levesque R, et al. A randomized trial of hemodiafiltration and change in cardiovascular parameters. Clin J Am Soc Nephrol. 2014;9(3):520–6. doi: 10.2215/CJN.07140713 24408114

8. Peters SAE, Bots ML, Canaud B, Davenport A, Grooteman MPC, Kircelli F, et al. Haemodiafiltration and mortality in end-stage kidney disease patients: A pooled individual participant data analysis from four randomized controlled trials. Nephrol Dial Transplant. 2016;31(6):978–84. doi: 10.1093/ndt/gfv349 26492924

9. Mallamaci F, Zoccali C, Parlongo S, Tripepi G, Benedetto FA, Cutrupi S, et al. Troponin is related to left ventricular mass and predicts all-cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis [Internet]. 2002;40(1):68–75. Available from: http://dx.doi.org/10.1053/ajkd.2002.33914 12087563

10. DeFilippi C, Wasserman S, Rosanio S, Tiblier E, Sperger H, Tocchi M, et al. Cardiac troponin T and C-reactive protein for predicting prognosis, coronary atherosclerosis, and cardiomyopathy in patients undergoing long-term hemodialysis. J Am Med Assoc. 2003;290(3):353–9.

11. Iliou MC, Fumeron C, Benoit MO, Tuppin P, Courvoisier CL, Calonge VM, et al. Factors associated with increased serum levels of cardiac troponins T and I in chronic haemodialysis patients: Chronic Haemodialysis And New Cardiac Markers Evaluation (CHANCE) study. Nephrol Dial Transplant. 2001;16(7):1452–8. doi: 10.1093/ndt/16.7.1452 11427640

12. Ooi DS, Zimmerman D, Graham J, Wells GA. Cardiac troponin T predicts long-term outcomes in hemodialysis patients. Clin Chem. 2001;47(3):412–7. 11238290

13. Dubin RF, Li Y, He J, Jaar BG, Kallem R, Lash JP, et al. Predictors of high sensitivity cardiac troponin T in chronic kidney disease patients: A cross-sectional study in the chronic renal insufficiency cohort (CRIC). BMC Nephrol [Internet]. 2013;14(229). Available from: http://www.scopus.com/inward/record.url?eid=2-s2.0-84886931718&partnerID=40&md5=64928cdb0b7a5302379364e9278771c6

14. McGill D, Talaulikar G, Potter JM, Koerbin G, Hickman PE. Over time, high-sensitivity TnT replaces NT-proBNP as the most powerful predictor of death in patients with dialysis-dependent chronic renal failure. Clin Chim Acta [Internet]. 2010;411(13–14):936–9. Available from: http://dx.doi.org/10.1016/j.cca.2010.03.004 20298685

15. Pianta TJ, Horvath AR, Ellis VM, Leonetti R, Moffat C, Josland EA, et al. Cardiac high-sensitivity troponin T measurement: A layer of complexity in managing haemodialysis patients. Nephrology. 2012;17(7):636–41. doi: 10.1111/j.1440-1797.2012.01625.x 22694299

16. Wolley M, Stewart R, Curry E, Davidson J, White H, Pilmore H. Variation in and prognostic importance of troponin T measured using a high-sensitivity assay in clinically stable haemodialysis patients. Clin Kidney J. 2013;6(4):402–9. doi: 10.1093/ckj/sfs122 27293568

17. Quiroga B, Vega A, Abad S, Villaverde M, Reque J, López-Gómez JM. Creatine-kinase and dialysis patients, a helpful tool for stratifying cardiovascular risk ? NEFROLOGíA [Internet]. 2016;36(1):51–6. Available from: http://dx.doi.org/10.1016/j.nefro.2015.10.004

18. Laveborn E, Lindmark K, Skagerlind M, Stegmayr B. NT-proBNP and troponin T levels differ after haemodialysis with a low versus high flux membrane. Int J Artif Organs [Internet]. 2015;38(2):69–75. Available from: http://www.artificial-organs.com/article/nt-probnp-and-troponin-t-levels-differ-after-haemodialysis-with-a-low-versus-high-flux-membrane 25744196

19. Zoccali C, Benedetto FA, Mallamaci F, Tripepi G, Giacone G, Stancanelli B, et al. Left ventricular mass monitoring in the follow-up of dialysis patients: Prognostic value of left ventricular hypertrophy progression. Kidney Int. 2004;65(4):1492–8. doi: 10.1111/j.1523-1755.2004.00530.x 15086493

20. Derthoo D, Belmans A, Claes K, Bammens B, Ciarka A, Droogné W, et al. Survival and heart failure therapy in chronic dialysis patients with heart failure and reduced left ventricular ejection fraction: an observational retrospective study. Acta Cardiol. 2013;68(1):51–7. doi: 10.2143/AC.68.1.2959632 23457910

21. Rodriguez Castellanos F, Meave A, Paniagua Sierra R. Effects of high-efficiency postdilution online hemodiafiltration and high-flux hemodialysis on serum phosphorus and cardiac structure and function in patients with end-stage renal disease. Int Urol Nephrol. 2013;45:1373–8. doi: 10.1007/s11255-012-0324-8 23143753

22. Penne EL, Blankestijn PJ, Bots ML, van den Dorpel MA, Grooteman MP, Nubé MJ, et al. Effect of increased convective clearance by on-line hemodiafiltration on all cause and cardiovascular mortality in chronic hemodialysis patients–the Dutch CONvective TRAnsport STudy (CONTRAST): rationale and design of a randomised controlled trial [ISRC. Curr Control Trials Cardiovasc Med. 2005;6(8):1–10.

23. Lévesque R, Marcelli D, Cardinal H, Caron M, Grooteman MPC, Bots ML, et al. Cost-Effectiveness Analysis of High-Efficiency Hemodiafiltration Versus Low-Flux Hemodialysis Based on the Canadian Arm of the CONTRAST Study. Appl Health Econ Health Policy. 2015;13:647–59. doi: 10.1007/s40258-015-0179-0 26071951

24. Bergström J, Wehle B. No change in corrected beta 2-microglobulin concentration after cuprophane haemodialysis. Lancet. 1987;(8533):628–9. doi: 10.1016/s0140-6736(87)90266-2 2881162

25. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr [Internet]. 2015;16(3):233–71. Available from: http://dx.doi.org/10.1016/j.echo.2014.10.003

26. Mosteller R. Simplified calculation of body-surface area. N Engl J Med. 1987;317(17):1098. doi: 10.1056/NEJM198710223171717 3657876

27. Nubé MJ, Peters SAE, Blankestijn PJ, Canaud B, Davenport A, Grooteman MPC, et al. Mortality reduction by post-dilution online-haemodiafiltration : a cause-specific analysis. Nephrol Dial Transplant. 2017;32:548–55. doi: 10.1093/ndt/gfw381 28025382

28. Cheung AK, Sarnak MJ, Yan G, Dwyer JT, Heyka RJ, Rocco MV, et al. Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients. Kidney Int. 2000;58(1):353–62. doi: 10.1046/j.1523-1755.2000.00173.x 10886582

29. Zoccali C, Mallamaci F, Tripepi G. Traditional and emerging cardiovascular risk factors in end-stage renal disease. Kidney Int [Internet]. 2003;63:S105–10. Available from: http://www.nature.com/ki/journal/v63/n85s/full/4493831a.html

30. Stenvinkel P. Inflammation in end-stage renal disease: The hidden enemy. Nephrology. 2006;11(1):36–41. doi: 10.1111/j.1440-1797.2006.00541.x 16509930

31. Wu AHB. Cardiac troponin: Friend of the cardiac physician, foe to the cardiac patient? Circulation. 2006;114(16):1673–5. doi: 10.1161/CIRCULATIONAHA.106.652123 17043176

32. Tripepi G, Pannier B, D’Arrigo G, Mallamaci F, Zoccali C, London G. Reappraisal in two European cohorts of the prognostic power of left ventricular mass index in chronic kidney failure. Kidney Int. 2017;91:704–10. doi: 10.1016/j.kint.2016.10.012 28010886

33. Fahim MA, Hayen AD, Horvath AR, Dimeski G, Coburn A, Tan K, et al. Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice. 2015;53(5):715–22.

34. Assa S, Gansevoort RT, Westerhuis R. Determinants and prognostic significance of an intra-dialysis rise of cardiac troponin I measured by sensitive assay in hemodialysis patients. Clin Res Cardiol. 2013;102:439–45. doi: 10.1007/s00392-013-0551-8 23397594

35. Cardinaels EPM, Cornelis T, van der Sande FM, Leunissen KM, van Dieijen-Visser MP, Mingels AMA, et al. Acute effects of conventional and extended hemodialysis and hemodiafiltration on high-sensitivity cardiac troponins. Clin Chem Lab Med. 2015;(May).

Článek vyšel v časopise


2019 Číslo 10