Title : CARDIAC TROPONIN AND HOMOCYSTEINE LEVELS IN HEMODIALYSIS PATIENTS: ASSOCIATION WITH DIALYSIS VINTAGE AND CARDIOVASCULAR COMORBIDITY
Abstract:
INTRODUCTION: Cardiovascular disease remains the leading cause of morbidity and mortality in patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis. Elevated cardiac troponin and homocysteine concentrations are frequently observed in this population, reflecting chronic myocardial injury, endothelial dysfunction, inflammation, and accelerated atherosclerosis. However, the impact of time on renal replacement therapy on these biomarkers remains incompletely understood. This study investigated the association between dialysis vintage, circulating troponin and homocysteine levels, and major cardiovascular risk factors in chronic hemodialysis patients.
MATERIALS AND METHODS: This prospective observational study included 187 adult ESRD patients receiving maintenance hemodialysis in two tertiary dialysis centers. Patients were categorized according to time on renal replacement therapy into three groups: <5 years (n=85), 5–10 years (n=58), and >10 years (n=44). Troponin levels were measured at baseline and at 3, 6, 9, and 12 months, while homocysteine levels were assessed at baseline, 6, and 12 months. Subgroup analyses were performed according to sex, presence of coronary artery disease (CAD), arterial hypertension, antihypertensive treatment, and lipid-lowering therapy. Statistical analyses included Kruskal–Wallis, Mann–Whitney U, Fisher’s exact test, and Spearman correlation. A p-value <0.05 was considered statistically significant.
RESULTS: Elevated troponin levels (>15 pg/mL) were detected in 89.25% of patients, while hyperhomocysteinemia was present in 98% of the study population. No significant differences were observed in mean troponin or homocysteine levels among the three dialysis-duration groups (p=0.589 and p=0.683, respectively). Furthermore, no significant correlation was identified between dialysis vintage and biomarker
concentrations (troponin: Spearman rho=-0.061, p=0.405; homocysteine: rho=0.015, p=0.860). Patients with established CAD exhibited significantly higher troponin levels than those without CAD (74.10 vs. 37.50 pg/mL, p<0.001), whereas homocysteine concentrations did not differ significantly between groups (p=0.694). No significant associations were observed between biomarker levels and sex, hypertension status, antihypertensive treatment, or lipid-lowering therapy.
CONCLUSIONS: Troponin and homocysteine elevations are highly prevalent among patients undergoing chronic hemodialysis. Dialysis vintage alone does not appear to influence circulating levels of either biomarker. In contrast, the presence of coronary artery disease is strongly associated with significantly increased troponin concentrations, suggesting that underlying cardiovascular pathology rather than dialysis vintage is the principal determinant of chronic troponin elevation in ESRD patients. These findings support the potential role of troponin as a marker of cardiovascular burden and risk stratification in the hemodialysis population.
