Intradialytic Kinetics of Cardiac Biomarkers During High-Flux Hemodialysis and Post-Dilution Hemodiafiltration: A Randomized Crossover Trial
In brief
Hemodiafiltration lowers high-sensitivity troponin I by about 8 ng/L and troponin T by about 23 ng/L
In a crossover trial of 23 stable dialysis patients, post-dilution hemodiafiltration produced modest but significant drops in both high-sensitivity troponin I and T, while conventional high-flux hemodialysis did not affect these markers. Natriuretic peptide fell with both modalities, but more with hemodiafiltration, suggesting that timing of blood draws relative to the last dialysis session is crucial for accurate cardiac biomarker interpretation.
- Journal
- Kidney360 (Q1)
- Published
- 20 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Caroline Liboriussen Drivsholm, Louis Nygaard, Gertrud Dam-Dalgeir, Rie Io Glerup, Allan Birnum, Jens Dam Jensen, et al.
- PMID
- 42475358
- DOI
- 10.34067/KID.0000001284
Why clinicians should know about it
- Picked for Nephrology (paper of the day, 21 July 2026).
Abstract
BACKGROUND: There are limited data on how hemodialysis influences cardiac biomarker concentrations. This study aimed to investigate concentration changes of high-sensitivity troponin I and T, and N-terminal pro-B-type natriuretic peptide before, during, and after hemodialysis and hemodiafiltration, and to compare these changes between the two dialysis modalities. METHODS: Randomized crossover study including 23 stable patients treated with hemodialysis/hemodiafiltration. Patients were randomized to start with high-flux hemodialysis or post-dilution hemodiafiltration, had a washout period of 1-3 weeks, and then crossed over to receive the other modality. Blood samples were collected before dialysis, after 10, 30, 60, 120, 180, and 240 minutes of dialysis, and 30 minutes post-dialysis. Additionally, spent dialysate was collected after 120 minutes of dialysis. Linear mixed-effects models were used to investigate concentration changes and compare dialysis modalities. RESULTS: High-sensitivity troponin I and high-sensitivity troponin T were not influenced by hemodialysis; however, hemodiafiltration resulted in a significant decline in both biomarkers. At the end of dialysis, the change was -7.7 ng/L (95% CI: -12.3 to -3.1) for high-sensitivity troponin I and -23.4 ng/L (95% CI: -31.8 to -15.0) for high-sensitivity troponin T. N-terminal pro-B-type natriuretic peptide was significantly reduced with both modalities, with a change of -2954 ng/L (95% CI: -4974 to -934) in hemodialysis and -5161 ng/L (95% CI: -7231 to -3092) in hemodiafiltration. All biomarker concentrations were significantly lower with hemodiafiltration compared to hemodialysis at the end of dialysis. CONCLUSIONS: High-sensitivity troponin I, high-sensitivity troponin T, and N-terminal pro-B-type natriuretic peptide were significantly reduced with hemodiafiltration in asymptomatic patients treated with dialysis. Hemodialysis reduced N-terminal pro-B-type natriuretic peptide. Cardiac biomarker levels are influenced by dialysis and treatment modality, which could lead to potential misinterpretation. This emphasizes that time since the last dialysis session should be considered when interpreting cardiac biomarkers for diagnostic purposes.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.