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  • Biological variation of high sensitivity cardiac troponin-T in stable dialysis patients: implications for clinical practice

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    Author(s)
    Fahim, Magid A
    Hayen, Andrew D
    Horvath, Andrea R
    Dimeski, Goce
    Coburn, Amanda
    Tan, Ken-Soon
    Johnson, David W
    Craig, Jonathan C
    Campbell, Scott B
    Hawley, Carmel M
    Griffith University Author(s)
    Tan, Ken-Soon
    Year published
    2015
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    Abstract
    Background: Changes in high sensitivity cardiac troponin-T (hs-cTnT) concentrations may reflect either acute myocardial injury or biological variation. Distinguishing between these entities is essential to accurate diagnosis, however, the biological variation of hs-cTnT in dialysis population is currently unknown. We sought to estimate the within- and between-person coefficients of variation of hs-cTnT in stable dialysis patients, and derive the critical difference between measurements needed to exclude biological variation with 99% confidence. Methods: Fifty-five prevalent haemo- and peritoneal-dialysis patients attending ...
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    Background: Changes in high sensitivity cardiac troponin-T (hs-cTnT) concentrations may reflect either acute myocardial injury or biological variation. Distinguishing between these entities is essential to accurate diagnosis, however, the biological variation of hs-cTnT in dialysis population is currently unknown. We sought to estimate the within- and between-person coefficients of variation of hs-cTnT in stable dialysis patients, and derive the critical difference between measurements needed to exclude biological variation with 99% confidence. Methods: Fifty-five prevalent haemo- and peritoneal-dialysis patients attending two metropolitan hospitals were assessed on 10 consecutive occasions; weekly for 5 weeks then monthly for 4 months. Assessments were conducted at the same dialysis cycle time-point and entailed hs-cTnT testing, clinical review, electrocardiography, and bioimpedance spectroscopy. Patients were excluded if they developed clinical or physiological instability. Results: In total 137 weekly and 114 monthly hs-cTnT measurements from 42 stable patients were analysed. Respective between- and within-person coefficients of variation were 83% and 7.9% for weekly measurements, and 79% and 12.6% for monthly measurements. Within-person variation was unaffected by dialysis modality or cardiac co-morbidity. The bidirectional 99% reference change value was -25% and +33% for weekly measurements, and -37% and +58% for monthly measurements. Conclusions: The between-person variation of hs-cTnT in the dialysis population is markedly greater than within-person variation indicating that hs-cTnT testing is best applied in this population using a relative change strategy. An increase of 33% or a reduction of 25% in serial hs-cTnT concentrations measured at weekly intervals excludes change due to analytical and biological variation alone with 99% confidence.
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    Journal Title
    Clinical Chemistry and Laboratory Medicine (CCLM)
    Volume
    53
    Issue
    5
    DOI
    https://doi.org/10.1515/cclm-2014-0838
    Copyright Statement
    © 2015 Walter de Gruyter & Co. KG Publishers. The attached file is reproduced here in accordance with the copyright policy of the publisher. Please refer to the journal's website for access to the definitive, published version.
    Subject
    Clinical sciences
    Cognitive and computational psychology
    Science & Technology
    Life Sciences & Biomedicine
    Medical Laboratory Technology
    renal dialysis
    troponin T
    Publication URI
    http://hdl.handle.net/10072/397520
    Collection
    • Journal articles

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