Gremaud S, Fellay B, Hemett OM, et al. - Analyzing high-sensitivity cardiac troponin T (hs-cTnT) levels every month for 1 year in asymptomatic hemodialysis patients, persistently higher than normal levels of hs-cTnT were found in chronic hemodialysis patients.

• In 44 hemodialysis patients (mean age 67 ± 14 years), predialysis levels of fifth-generation hs-cTnT, creatine kinase (CK), and CK-MB were recorded every month for 1 year.

• Higher than normal (N < 14 ng/L) levels were evident in almost 100% of hs-cTnT measurements; the mean ± SD annual level was 84 ± 59 ng/L, ranging from a minimum of 24 ± 2 to 241 ± 28 ng/L in individual patients.

• Mean levels of CK and CK-MB were normal, and 13 myocardial infarctions were all related to an initial increase in hs-cTnT >45% from the individual baseline value; CK and CK-MB only rose in 38% and 31% of these myocardial infarctions, respectively.

• Use of higher cut-offs as proposed in the literature cannot be supported, and hs-cTnT is needed to be measured at regular intervals (e.g., every 3–6 months) in order to establish individual baseline levels for hs-cTnT.

• This strategy, in most instances, allows to more rapidly rule-in as well as to rapidly rule-out, cases of acute coronary syndromes in hemodialysis patients who develop cardiac symptoms.