Troponina T ultrasensible y CA125 como marcadores pronósticos en pacientes con enfermedad renal terminal en hemodiálisis
Palabras clave:
Diálisis Renal, Marcadores Biológicos, Troponina T, Antígeno Ca-125, Síndrome Coronario AgudoResumen
Introducción: Los pacientes con enfermedad renal terminal (ERT) en hemodiálisis (HD) tienen una alta morbimortalidad, principalmente debido a enfermedades cardiovasculares (CV). Los biomarcadores, como la troponina T ultrasensible (TnTUS) y el antígeno carbohidrato 125 (CA125), sirven para establecer pronóstico CV y tratar adecuadamente y de manera preventiva a los pacientes con un riesgo más elevado.
Materiales y Métodos: Se incluyeron pacientes con ERT y al menos tres meses de HD, midiendo en una muestra de plasma los marcadores TnTUS y CA125. Aquellos con evidencia clínica de estar cursando un síndrome coronario agudo fueron excluidos. Se realizó seguimiento por 12 meses donde se valoraron los eventos CV y las hospitalizaciones por cualquier causa.
Resultados: Se incluyeron 87 pacientes de 58±15 años, 76% de sexo masculino. La mediana de TnTUS basal fue de 49 ng/l (15,3 – 214,1) encontrándose elevada en 95,4% de los pacientes. La mediana de CA125 fue 13,7 U/ml (6,1 – 52,7). Los pacientes que presentaron una MACE, tenían valores más elevados de CA125 (p<0,03) y TnTUS (p<0,001), y todos ellos presentaban un valor de TnTUS ? 69,37 ng/l.
Conclusión: Los pacientes con ERT en HD tienen una prevalencia de niveles elevados de TnTUS de 95,4% y de CA125 de 10%. Los pacientes con MACE tuvieron significativamente valores más elevados de ambos marcadores, pudiendo determinar que poseen valor pronóstico en este grupo de pacientes.Descargas
Referencias
1. Kidney Disease Statistics for the United States | National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). http://www.niddk.nih.gov/health-information/health-statistics/Pages/kidney-disease-statistics-united-states.aspx#7. Acceso: 9 de Diciembre de 2015.
2. Byrne C. Effect of Age and Diagnosis on Survival of Older Patients Beginning Chronic Dialysis. JAMA J Am Med Assoc. 1994;271(1):34.
3. de Jager DJ, Grootendorst DC, Jager KJ, et al. Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA. 2009;302(16):1782-9.
4. Morbidity and Mortality of Renal Dialysis: An NIH Consensus Conference Statement. Ann Intern Med. 1994;121(1):62.
5. Wu AH., Ford L. Release of cardiac troponin in acute coronary syndromes: ischemia or necrosis? Clin Chim Acta. 1999;284(2):161-74.
6. Freda BJ, Tang WHW, Van Lente F, Peacock WF, Francis GS. Cardiac troponins in renal insufficiency. J Am Coll Cardiol. 2002;40(12):2065-71.
7. Artunc F, Haap M, Heyne N, Weyrich P, Wolf S. [Interpretation of elevated serum troponin levels in end stage renal disease - case 2/2010]. Dtsch Med Wochenschr. 2010;135(6):240.
8. Katus HA, Haller C, Müller-Bardorff M, Scheffold T, Remppis A. Cardiac troponin T in end-stage renal disease patients undergoing chronic maintenance hemodialysis. Clin Chem. 1995;41(8 Pt 1):1201-3.
9. Porter GA, Norton T, Bennett WB. Troponin T, a predictor of death in chronic haemodialysis patients. Eur Heart J. 1998;19 Suppl N:N34-N37.
10. Stolear JC. The predictive value of cardiac troponin T measurements in subjects on regular haemodialysis. Nephrol Dial Transplant. 1999;14(8):1961-7.
11. Dierkes J, Domrose U, Westphal S, et al. Cardiac Troponin T Predicts Mortality in Patients With End-Stage Renal Disease. Circulation. 2000;102(16):1964-9.
12. Apple FS. Predictive Value of Cardiac Troponin I and T for Subsequent Death in End-Stage Renal Disease. Circulation. 2002;106(23):2941-5.
13. Mallamaci F, Zoccali C, Parlongo S, et al. Troponin is related to left ventricular mass and predicts all-cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis. 2002;40(1):68-75.
14. Jacobs LH, van de Kerkhof J, Mingels AM, et al. Haemodialysis patients longitudinally assessed by highly sensitive cardiac troponin T and commercial cardiac troponin T and cardiac troponin I assays. Ann Clin Biochem. 2009;46(Pt 4):283-90.
15. McGill D, Talaulikar G, Potter JM, Koerbin G, Hickman PE. Over time, high-sensitivity TnT replaces NT-proBNP as the most powerful predictor of death in patients with dialysis-dependent chronic renal failure. Clin Chim Acta. 2010;411(13-14):936-9.
16. Kumar N, Michelis MF, DeVita M V, Panagopoulos G, Rosenstock JL. Troponin I levels in asymptomatic patients on haemodialysis using a high-sensitivity assay. Nephrol Dial Transplant. 2011;26(2):665-70.
17. Bast RC, Klug TL, St John E, et al. A radioimmunoassay using a monoclonal antibody to monitor the course of epithelial ovarian cancer. N Engl J Med. 1983;309(15):883-7.
18. Canney PA, Moore M, Wilkinson PM, James RD. Ovarian cancer antigen CA125: a prospective clinical assessment of its role as a tumour marker. Br J Cancer. 1984;50(6):765-9.
19. Camera A, Villa MR, Rocco S, et al. Increased CA 125 serum levels in patients with advanced acute leukemia with serosal involvement. Cancer. 2000;88(1):75-8.
20. Zacharos ID, Efstathiou SP, Petreli E, et al. The prognostic significance of CA?125 in patients with non-Hodgkin’s lymphoma. Eur J Haematol. 2002;69(4):221-6.
21. Sakamoto K, Haga Y, Yoshimura R, Egami H, Yokoyama Y, Akagi M. Comparative effectiveness of the tumour diagnostics, CA 19-9, CA 125 and carcinoembryonic antigen in patients with diseases of the digestive system. Gut. 1987;28(3):323-9.
22. Bergmann JF, Bidart JM, George M, Beaugrand M, Levy VG, Bohuon C. Elevation of CA 125 in patients with benign and malignant ascites. Cancer. 1987;59(2):213-7.
23. Seo T, Ikeda Y, Onaka H, et al. Usefulness of serum CA125 measurement for monitoring pericardial effusion. Jpn Circ J. 1993;57(6):489-94.
24. Kouris NT, Kontogianni DD, Papoulia EP, et al. Clinical and prognostic value of elevated CA125 levels in patients with congestive heart failure. Hellenic J Cardiol. 47(5):269-74.
25. Turgut O, Tandogan I, Yilmaz MB, Gul I, Gurlek A. CA125 levels among patients with advanced heart failure: an emerging independent predictor for survival. Int J Cardiol. 2010;145(1):71.
26. Núñez J, Miñana G, Núñez E, Chorro FJ, Bodí V, Sanchis J. Clinical utility of antigen carbohydrate 125 in heart failure. Heart Fail Rev. 2014;19(5):575-84.
27. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Eur Heart J. 2012;33(20):2551-67.
28. Alagoz T, Buller RE, Berman M, Anderson B, Manetta A, DiSaia P. What is a normal CA125 level? Gynecol Oncol. 1994;53(1):93-7.
29. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiograph. J Am Soc Echocardiogr. 2005;18(12):1440-63.
30. deFilippi C, Wasserman S, Rosanio S, et al. Cardiac troponin T and C-reactive protein for predicting prognosis, coronary atherosclerosis, and cardiomyopathy in patients undergoing long-term hemodialysis. JAMA. 2003;290(3):353-9.
31. Tzitzikos G, Saridi M, Filippopoulou T, et al. Measurement of tumor markers in chronic hemodialysis patients. Saudi J Kidney Dis Transpl. 2010;21(1):50-3.
32. Artunc F, Mueller C, Breidthardt T, et al. Sensitive troponins--which suits better for hemodialysis patients? Associated factors and prediction of mortality. PLoS One. 2012;7(10):e47610.
33. Ellis K, Dreisbach AW, Lertora JL. Plasma elimination of cardiac troponin I in end-stage renal disease. South Med J. 2001;94(10):993-6.
34. Hayashi T, Obi Y, Kimura T, et al. Cardiac troponin T predicts occult coronary artery stenosis in patients with chronic kidney disease at the start of renal replacement therapy. Nephrol Dial Transplant. 2008;23(9):2936-42.
35. Mallamaci F, Zoccali C, Parlongo S, et al. Diagnostic value of troponin T for alterations in left ventricular mass and function in dialysis patients. Kidney Int. 2002;62(5):1884-90.
36. Bastani B, Chu N. Serum CA-125 level in end-stage renal disease patients maintained on chronic peritoneal dialysis or hemodialysis: the effect of continuous presence of peritoneal fluid, peritonitis, and peritoneal catheter implantation. Am J Nephrol. 1995;15(6):468-72.
37. Krediet RT. Dialysate cancer antigen 125 concentration as marker of peritoneal membrane status in patients treated with chronic peritoneal dialysis. Perit Dial Int. 21(6):560-7.
38. Kanjanabuch T, Puttipittayathorn N, Leelahavanichkul A, et al. Exfoliated mesothelial cell and CA-125 in automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) patients. J Med Assoc Thai. 2011;94 Suppl 4:S119-S125.
39. Varol E, Yücel H, Arslan A, Ozayd?n M, Erdo?an D, Do?an A. Elevated carbohydrate antigen 125 levels in patients with aortic stenosis: relation to clinical severity and echocardiographic parameters. Türk Kardiyol Derne?i ar?iviTürk Kardiyol Derne?inin yay?n organ?d?r. 2012;40(4):309-15.
40. Sen T, Aksu T, Yilmaz MB. Carbohydrate antigen-125 is a mirror of both left and right sides of the heart. Tex Heart Inst J. 2012;39(4):603-4.
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