Serial versus single troponin measurements for the prediction of cardiovascular events and mortality in stable chronic haemodialysis patients

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It has been demonstrated that elevated troponin T and I values are associated with higher risk of cardiovascular mortality, all‐cause mortality or major adverse cardiovascular events (MACEs) in haemodialysis (HD) patients.1 Most of the studies evaluating the prognostic significance of high troponins were based on single pre‐dialysis troponin measurements. However, troponin levels may fluctuate between sessions with certain patients having consistently elevated troponin levels and others having isolated elevations.3
Although several studies have considered serial troponin measurement as a tool for risk stratification in asymptomatic HD patients, it has not been established whether this approach offers any prognostic advantage compared with a single mid‐week troponin measurement.4 It is also unclear how many elevated troponin values confer a higher risk for adverse outcomes.
The aim of this study was to describe the variability of pre‐dialysis troponin values in clinically stable HD patients and compare the performance of single versus fluctuating or persistently elevated troponin levels in predicting a composite of mortality and cardiovascular outcomes.
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