Abstract
The diagnostic approach to acute coronary syndrome (ACS) is challenging in patients with impaired renal function since most serum biomarkers are commonly increased in this clinical setting. Cardiac troponin T (cTnT), creatine kinase isoenzyme MB (CK MB), myoglobin, and ischemia modified albumin (IMA), were assayed in 45 patients prehemodialysis (preβHD) and posthemodialysis (postβHD), and results were adjusted for hemoconcentration. The preβHD values of serum IMA and cTnT were above the respective diagnostic thresholds (IMA<85βK units/L; cTnT <0.03βng/mL) in six (13%) and 27 (60%) patients undergoing chronic HD, respectively. A significant (105.0 vs. 79.0βK units/L, P<0.0001) and variable (+38%; 95% confidence interval [CI], 12β65%) increase of serum IMA was observed postβHD, whereas the other biomarkers significantly decreased (cTnT: 0.029 vs. 0.044βng/mL, P=0.016; CKβMB: 2.33 vs. 2.50βΒ΅g/L, P<0.0001; myoglobin: 128.1 vs. 148.7βΒ΅g/L, P<0.0001). Biomarkers of myocardial injury, especially cTnT and IMA, might be used in HD patients, provided that an appropriate diagnostic interpretation is guarantee, according to individual baseine value, metabolism, and time of sampling. Moreover, IMA might be reliably applied to stratify the longβterm risk of these patients, but not for diagnosing an ACS during or immediately postβHD. J. Clin. Lab. Anal. 22:59β65, 2008. Β© 2008 WileyβLiss, Inc.