Association of Cardiac Troponin I With Different Stages of Chronic Kidney Disease Among Patients with & without Acute Myocardial Infraction: A Cross Sectional Study at DMCH

Abstract

Objective: Chronic kidney disease (CKD) is a major risk factor for cardiovascular disease (CVD), contributing to substantial amount of mortality and morbidity. Cardiac troponin I has been in use as a biomarker to identify patients with acute myocardial infarction, but among CKD patients, elevated troponin I levels have been found frequently in the absence of acute myocardial infarction. Present study aimed to evaluate the association between cardiac troponin I levels with different stages of chronic kidney disease among patients with & without acute myocardial infraction. Methodology: A cross-sectional study was conducted among 72 diagnosed cases of CKD patients from Department of Nephrology, Dhaka Medical College Hospital, Dhaka, from January 2015 to December 2015. Purposive sampling technique was used. Both male and female patients with different stages of CKD with symptoms of acute coronary syndrome were enrolled in the study.  Ethical clearance was obtained from the Institutional Review Board (IRB) of Dhaka Medical College Hospital (DMCH). Selected CKD patients’ CBC and serum troponin I were done and recorded. ECG for all the patients were also performed and the results were recorded. Result: Mean age of the study population was 46.9 ± 12.9 years. Male gender was predominant among the study population (72.2%). Glomerulonephritis (45.8%) was the predominant cause of CKD among study population. As for stages of CKD, 41.7% respondents were from stage 5, followed by 38.9% from stage 5D, 11.1% from stage 4 and 8.3% from stage 3. According to ECG report, 27.8% had acute MI. For respondents with a normal ECG report, mean serum troponin I was 24.3 ± 27.2 ng/dl, and for respondents showing acute MI on ECG report, mean serum troponin I was 4585.5 ± 10978.3 ng/dl. There was statistically significant (p < 0.05) difference between these two groups. Patients with CKD stage 3 had mean serum troponin I of 1.49 ± 2.36 ng/dl, CKD stage 4 had mean serum troponin I of 3.69 ± 3.26 ng/dl, CKD stage 5 had mean serum troponin I of 15.44 ± 20.49 ng/dl and CKD stage 5D had mean serum troponin I of 44.84 ± 27.16 ng/dl. Statistically significant (p < 0.05) difference was found among four groups. Conclusion: Serum troponin I is elevated in CKD patients with or without acute coronary syndrome. Serum troponin I is markedly raised in CKD patients with acute coronary syndrome and is comparatively more raised in advanced stages of CKD than early stage in CKD patients without acute coronary syndrome.