Troponin levels in hypervolemic chronic renal failure patients and the effects of medical diuresis treatment on troponin levels

Objective: In patients with chronic renal failure (CRF), troponin values can be found to be clinically high in non-acute coronary (ACS) syndrome cases. Recent studies show that high troponin values, regardless of source and cause, indicate myocardial damage in patients with CRF. The two most important causes of increase in cardiac troponin levels are myocardial damage due to increased left ventricular wall tension due to left ventricular hypertrophy (LVH) and chronic hypervolemia. CRF is one of the most important causes of hypervolemia. We have had clinical observations of elevated troponin levels in hypervolemic CRF cases that we followed. Patients with high troponin levels are referred as ACS and coronary angiography is often recommended. Angiography procedures can cause contrast nephropathy and aggravate renal dysfunction. It can even cause irreversible renal damage, causing patients to undergo routine hemodialysis. In patients with CRF, non-ACS conditions that lead to troponin elevation should be considered before deciding on invasive coronary angiographic procedures that may adversely affect the progression and prognosis of the disease. Therefore, the aim of this study is to observe the effect of medical diuresis and volume reduction on troponin I level in patients with high troponin I value and whether there is a relationship between Troponin I (cTnI) level and hypervolemia in patients with CRF. Material and methods: The study was carried out in 40 patients between the ages of 18-90 who were admitted to the Yüzüncü Yıl University (YYÜ) Faculty of Medicine Dursun Odabaş Medical Center and hospitalized for CRF and hypervolemia between December 2019 -March 2020. CRF was diagnosed according to the patient's previous creatinine values and renal USG findings, while hypervolemia was determined by considering clinical findings, physical examination and imaging methods. In addition to demographic data, detailed anamnesis information, aetiology of CRF, blood pressure, monitoring fluid intake and output during treatment, weight changes during treatment, echocardiography findings were recorded. The eGFR values of the patients were calculated according to the MDRD formula. Diuretic treatment of patients during hospitalization for hypervolemia (iv furosemide) was initiated. According to the findings of the daily physical examination, either diuretic infusion therapy or diuretic in divided doses (iv furosemide) was given. In terms of evaluation of treatment response, physical examination, fluid intake and output monitoring and weight follow-up were performed. Troponin I value was requested from these patients who were at risk from cardiologic point of view during hospitalization. Troponin follow-up was continued in patients with high troponin I values in hospitalization (in order to exclude ACS). During hospitalization of patients excluded from ACS by troponin follow-up, troponin I levels at 24. hour and 72. hours were recorded. Patients who were not within the specified age range at the time of diagnosis, patienst who didn't meet the criteria for diagnosis of chronic kidney failure, patients with acute renal failure, routine dialysis patients, pregnant women, malignancy patients, patients with ACS during hospitalization or follow-up were not included in the study. Findings: The age range of our patient group was 67.97±11,178. Our study consisted of 27 female (67.5%), 13 male (32.5%) patients, 16 patients (40%) were Stage 3, 14 patients (35%) were Stage 4, 10 patients (25%) were Stage 5 CRF that had not yet undergone dialysis. In the study for the etiology of chronic kidney failure, 16 patients had DM (40%), 13 patients had HT (32.5%), 4 patients had analgesic use (10%), 2 patients had glomerulonephritis (5%) and 5 patients had other causes. Troponin I values were found to be statistically significantly high at the time of hospitalization. In addition, in patients with high hospitalization troponin I values, troponin values measured at different time points during medical diuresis treatment (hospitalization, 24. hour and 72. hour) showed a statistically significant decrease. There was a significant relationship between troponin I values at the time of hospitalization and the presence of cardiomegaly, presence of pleural effusion, high PAP level, weight change and weight change percentage.