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# During a single dialysis session, troponin I can drift either way, a systematic review finds
- URL: https://nephspace.com/troponin-i-during-dialysis-review/
- Published: 2026-10-05T09:58:00.000Z
- Updated: 2026-10-05T09:57:59.000Z
- Description: Across 28 small studies of patients without symptoms, troponin I was above the 99th percentile on average before and after dialysis, and changes during a session did not follow a consistent direction.
- Author: Dr Wael Hussein
- Tags: Dialysis, #story, #has-audio, #in-center-dialysis, #review, #full-story, Stories

### The question

The definition of myocardial infarction requires troponin above the 99th percentile together with a rise or fall, and a change of 20% is the threshold used for patients on dialysis. People on hemodialysis often have high troponin at baseline, and the dialysis session itself may change it. Johan Jørgensen, Dr. Jan Kampmann and colleagues in southern Denmark asked what a single session does to troponin I in patients with no sign of acute cardiac injury.

### What they did

They searched five databases from inception to October 2025 and included 28 studies, with 9 to 200 patients each, that measured troponin I before and after dialysis. Because the studies reported a mix of means and medians, the authors summarized them descriptively rather than pooling them.

### What they found

- Averaging the studies' reported values, troponin I was 68 ng/L before dialysis and 73 ng/L after, both above the 99th percentile, in people without symptoms.
- Changes during a session ranged from −100% to +933%. At the extremes, one study from 2000 reported a fall from 300 ng/L to zero, and another a rise from 30 to 310 ng/L, which the authors treat as an outlier. They could not confirm either with the original investigators.
- By our count of the paper's table, about two-thirds of study results stayed within 20% either way, but several others moved 30% to 75%, past the infarction threshold.
- The direction was inconsistent, and no factor the authors examined explained it, including filter type and correction for ultrafiltration. Subgroups were too small to compare dialysis modalities.
- Of 10 studies with high-sensitivity assays, 7 showed a fall after dialysis, compared with 3 of 17 studies with standard assays. In one study, 4-hour sessions raised troponin I and 8-hour sessions lowered it.

### Why it matters

The authors conclude that the high baseline and unpredictable changes during dialysis make the current infarction criteria hard to apply in hemodialysis. One in-vitro study found that troponin I can adhere to polysulfone dialyzer membranes, although the authors think this has little or no effect in patients. Dialysis can also cause transient myocardial ischemia and stunning, which may raise troponin. Our take, not the paper's advice: a change across one session may reflect the session rather than a new infarct, so note when a troponin was drawn relative to dialysis, compare like with like, and let the ECG and clinical picture carry the diagnosis.

### Caveats

The included studies were small and often old, many did not report dialysis details, and all involved patients without symptoms, so the findings cannot be applied directly to patients having a myocardial infarction. The authors call for studies testing whether the 20% threshold is valid in hemodialysis. No funding was reported and the authors declare no conflicts of interest.

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**The source:** Jørgensen JF, Brandt F, Hunderup MW, Kampmann JD. The Intradialytic Changes in Cardiac Troponin I — A Systematic Review. Semin Dial. Published online 2026 (open access). doi:10.1111/sdi.70049 [Read the original](https://doi.org/10.1111/sdi.70049?ref=nephspace.com)

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