Serum cardiac markers in hemodialysis patients.
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Levels of creatinine phosphokinase (CPK), creatinine phosphokinase-MB isozyme (CPK-MB), myoglobin and myosin light chain 1 (MCL1) can be increased in patients with renal failure in the absence of myocardial injury, causing diagnostic confusion.The study included 33 patients (mean age 55 years (±10SD); 27 males ana 7 females), all of whom were undergoing long term hemodialysis. The control group consisted of 20 patients without ischemic heart disease (IHD). The remaining 13 patients had IHD. The IHD group consisted of 3 old myocardial infarction and 9 angina pectoris patients. Two of the patients in the IHD group had chest pain with significant ECG changes at some stage during the trial period. None of the patients received intramuscular injections or had any skeletal muscle disease. We measured serum levels of CPK, CPK-MB, myoglobin, MLC1 and troponin T (TnT) prior to the hemodialysis procedure. There was a significant correlation between TnT and MLC1 (r=0.717, p<0.001). Structurally bound proteins, TnT and MLC1, showed significant differences between the IHD group and the control group. Free cytosolic makers, CPK, CPK-MB and myoglobin, revealed no differences between these two groups.Low molecular weight protein, under 40, 000M.W., is excreted by the renal system. Thus, the serum levels of MCL1, TnT and myoglobin were elevated in patients with renal failure. The lower the cardiospecificity, the greater was the accumulative effect of renal failure, Free cytosolic markers were effective for diagnosing IHD in the acute phase. Myoglobin was not, however, effective because it was elevated in all patients in the control group.TnT is effective for diagnosing IHD even in patients undergoing hemodialysis as TnT has high cardiospecificity and releasing kinetics for both structurally bound proteins and free cytosolic markers.
- 社団法人 日本透析医学会の論文
社団法人 日本透析医学会 | 論文
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