Troponina T ultrasensible y CA125 como marcadores pronósticos en pacientes con enfermedad renal terminal en hemodiálisis

Juan S Moreno, Augusto José Lépori, Pablo Novoa, Rafael De Elias, Ricardo Guglielmone, Julio O Bono

Resumen


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.

Palabras clave


Diálisis Renal; Marcadores Biológicos; Troponina T; Antígeno Ca-125; Síndrome Coronario Agudo

Texto completo:

PDF

Referencias


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.

Byrne C. Effect of Age and Diagnosis on Survival of Older Patients Beginning Chronic Dialysis. JAMA J Am Med Assoc. 1994;271(1):34.

de Jager DJ, Grootendorst DC, Jager KJ, et al. Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA. 2009;302(16):1782-9.

Morbidity and Mortality of Renal Dialysis: An NIH Consensus Conference Statement. Ann Intern Med. 1994;121(1):62.

Wu AH., Ford L. Release of cardiac troponin in acute coronary syndromes: ischemia or necrosis? Clin Chim Acta. 1999;284(2):161-74.

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.

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.

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.

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.

Stolear JC. The predictive value of cardiac troponin T measurements in subjects on regular haemodialysis. Nephrol Dial Transplant. 1999;14(8):1961-7.

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.

Apple FS. Predictive Value of Cardiac Troponin I and T for Subsequent Death in End-Stage Renal Disease. Circulation. 2002;106(23):2941-5.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Eur Heart J. 2012;33(20):2551-67.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.




DOI: http://dx.doi.org/10.31053/1853.0605.v73.n1.13383

Enlaces refback

  • No hay ningún enlace refback.


Copyright (c) 2016 Universidad Nacional de Córdoba

Licencia de Creative Commons
Este obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.

Instrucciones para los autores

Revista de la Facultad de Ciencias Médicas.
Pabellón Perú - Ciudad Universitaria
Facultad de Ciencias Médicas.
Universidad Nacional de Córdoba.
Argentina
ISSN impreso: 0014-6722 | ISSN en linea: 1853-0605

revistafcm@fcm.unc.edu.ar