Published Online
on December 22, 2003

A more recent version of this article appeared on January 6, 2004

This Article Full Text (PDF) All Versions of this Article: 109/1/23    most recent 01.CIR.0000109483.45211.8Fv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Diris, J. H.C. Articles by van Dieijen-Visser, M. P. Search for Related Content PubMed PubMed Citation Articles by Diris, J. H.C. Articles by van Dieijen-Visser, M. P. Pubmed/NCBI databases Substance via MeSH Related Collections Biochemistry and metabolism Other diagnostic testing Acute myocardial infarction

Submitted on May 20, 2003
Revised on November 11, 2003
Accepted on November 14, 2003

Impaired Renal Clearance Explains Elevated Troponin T Fragments in Hemodialysis Patients

Jart H.C. Diris PhD^*, Christian M. Hackeng PhD, Jeroen P. Kooman MD, PhD, Yigal M. Pinto MD, PhD, Wim T. Hermens PhD, and Marja P. van Dieijen-Visser MD, PhD

From the Departments of Clinical Chemistry (J.H.C.D., C.M.H., M.P.v.D.-V.), Nephrology (J.P.K.), and Cardiology (Y.M.P.), University Hospital Maastricht, and the Cardiovascular Research Institute Maastricht (W.T.H), The Netherlands.

^* To whom correspondence should be addressed. E-mail: Diris{at}klinchem.azm.nl.

Background--Patients with severe renal dysfunction often have unexplained elevated serum concentrations of cardiac troponin T (cTnT). We investigated whether in vivo fragmentation of cTnT could explain these increases.

Methods and Results--cTnT, creatine kinase isoenzyme MB, and myoglobin serum concentrations were measured in all 63 dialysis patients of our in-hospital dialysis department. A highly sensitive immunoprecipitation assay, followed by electrophoresis and Western blotting, was used to extract and concentrate cTnT and its possible fragments from serum of these 63 hemodialysis patients. Although creatine kinase isoenzyme MB values excluded recent ischemic myocardial events in 55 of the 63 cases, cTnT fragments ranging in size from 8 to 25 kDa were present in the serum samples of all dialysis patients.

Conclusions--cTnT is fragmented into molecules small enough to be cleared by the kidneys of healthy subjects. Impaired renal function causes accumulation of these cTnT fragments and is very likely the cause of the unexplained elevations of serum cTnT found in patients with severe renal failure.

Key words: kidney • troponin T • plasma

This article has been cited by other articles:

				D. C Gaze and P. O Collinson Multiple molecular forms of circulating cardiac troponin: analytical and clinical significance Ann Clin Biochem, July 1, 2008; 45(4): 349 - 355. [Abstract] [Full Text] [PDF]

				R. Wiessner, K. Hannemann-Pohl, R. Ziebig, H. Grubitzsch, B. Hocher, O. Vargas-Hein, A. Lun, I. Schimke, and L. Liefeldt Impact of kidney function on plasma troponin concentrations after coronary artery bypass grafting Nephrol. Dial. Transplant., January 1, 2008; 23(1): 231 - 238. [Abstract] [Full Text] [PDF]

				A. Yee-Moon Wang, C. Wai-Kei Lam, M. Wang, I. Hiu-Shuen Chan, W. B. Goggins, C.-M. Yu, S.-F. Lui, and J. E Sanderson Prognostic Value of Cardiac Troponin T Is Independent of Inflammation, Residual Renal Function, and Cardiac Hypertrophy and Dysfunction in Peritoneal Dialysis Patients Clin. Chem., May 1, 2007; 53(5): 882 - 889. [Abstract] [Full Text] [PDF]

				R Sharma, D C Gaze, D Pellerin, R L Mehta, H Gregson, C P Streather, P O Collinson, and S J D Brecker Cardiac structural and functional abnormalities in end stage renal disease patients with elevated cardiac troponin T Heart, June 1, 2006; 92(6): 804 - 809. [Abstract] [Full Text] [PDF]

				W. Lim, D. J. Cook, L. E. Griffith, M. A. Crowther, and P. J. Devereaux Elevated Cardiac Troponin Levels in Critically Ill Patients: Prevalence, Incidence, and Outcomes Am. J. Crit. Care., May 1, 2006; 15(3): 280 - 288. [Abstract] [Full Text] [PDF]

				M. N. Fahie-Wilson, D. J. Carmichael, M. P. Delaney, P. E. Stevens, E. M. Hall, and E. J. Lamb Cardiac Troponin T Circulates in the Free, Intact Form in Patients with Kidney Failure Clin. Chem., March 1, 2006; 52(3): 414 - 420. [Abstract] [Full Text] [PDF]

				N. A. Abbas, R. I. John, M. C. Webb, M. E. Kempson, A. N. Potter, C. P. Price, S. Vickery, and E. J. Lamb Cardiac Troponins and Renal Function in Nondialysis Patients with Chronic Kidney Disease Clin. Chem., November 1, 2005; 51(11): 2059 - 2066. [Abstract] [Full Text] [PDF]

				A. Jeremias and C. M. Gibson Narrative Review: Alternative Causes for Elevated Cardiac Troponin Levels when Acute Coronary Syndromes Are Excluded Ann Intern Med, May 3, 2005; 142(9): 786 - 791. [Abstract] [Full Text] [PDF]

				D. Duman, S. Tokay, A. Toprak, D. Duman, A. Oktay, and I. C. Ozener Elevated cardiac troponin T is associated with increased left ventricular mass index and predicts mortality in continuous ambulatory peritoneal dialysis patients Nephrol. Dial. Transplant., May 1, 2005; 20(5): 962 - 967. [Abstract] [Full Text] [PDF]

				E. C.H.J. Michielsen, J. H.C. Diris, C. M. Hackeng, W. K.W.H. Wodzig, and M. P. Van Dieijen-Visser Highly Sensitive Immunoprecipitation Method for Extracting and Concentrating Low-Abundance Proteins from Human Serum Clin. Chem., January 1, 2005; 51(1): 222 - 224. [Full Text] [PDF]

				S. J. Cameron and G. B. Green Cardiac Biomarkers in Renal Disease: The Fog Is Slowly Lifting Clin. Chem., December 1, 2004; 50(12): 2233 - 2235. [Full Text] [PDF]

				E. Giannitsis, H. A. Katus, J. H.C. Diris, C. M. Hackeng, M. P. van Dieijen-Visser, J. P. Kooman, Y. M. Pinto, and W. T. Hermens Troponin T Release in Hemodialysis Patients * Response Circulation, July 20, 2004; 110(3): e25 - e26. [Full Text] [PDF]

				M. Panteghini Role and importance of biochemical markers in clinical cardiology Eur. Heart J., July 2, 2004; 25(14): 1187 - 1196. [Abstract] [Full Text] [PDF]