CHRONIC KIDNEY DISEASE AND DIAGNOSTIC ACCURACY OF HIGH-SENSITIVITY TROPONIN I IN ACUTE CORONARY SYNDROME

Abstract

Background: Acute coronary syndrome (ACS) is a major cause of heart-related illness and death. In patients with chronic kidney disease (CKD), it is hard to interpret high-sensitivity troponin I (hs-TnI) results because baseline levels may be consistently high.

Objective: To determine how the stage of CKD impacts the diagnostic accuracy of hs-TnI in patients being checked for ACS.

Material and Methods: This cross-sectional study took place in the Cardiology Department of Rehman Medical Institute, Peshawar, from January to April 2025. Out of 558 cardiac patients screened, 145 adults with CKD and symptoms of ACS were included. We recorded clinical symptoms, 12-lead electrocardiography, estimated glomerular filtration rate (eGFR), CKD stage, dialysis status, other health conditions, and hs-TnI levels. Data were analysed using SPSS version 27. Normality of age, eGFR, SBP, DBP, pulse pressure, and hs-TnI was assessed using the Shapiro-Wilk test and Q-Q plots. Means and standard deviations were calculated for normally distributed variables. Independent-samples t-test, one-way ANOVA, Pearson correlation, chi-square test, receiver operating characteristic analysis, and regression models were used as appropriate. A P value <0.05 was considered statistically significant.

Results: The average age of the patients was 59.48 ± 13.81 years. Among them, 91 (62.8%) were male and 54 (37.2%) were female. Patients with advanced CKD were older and had higher systolic blood pressure, diastolic blood pressure, pulse pressure, and ST-segment depression. hs-TnI levels varied across CKD stages according to one-way ANOVA (F = 5.126, P < 0.001), with the highest readings in stage 6. The area under the receiver operating characteristic curve was 0.594, showing weak ability to distinguish ACS in this CKD group..

Conclusion: hs-TnI levels increase with worsening CKD, so they should be interpreted carefully in this group. Diagnosing ACS in CKD patients should rely on the overall clinical situation, electrocardiographic results, and changes in biomarkers over time, rather than just one hs-TnI value.