TOPLINE

A crossover trial found that haemodiafiltration was associated with significantly lower concentrations of high-sensitivity cardiac troponin I (hs-cTnI), high-sensitivity cardiac troponin T (hs-cTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in asymptomatic patients undergoing dialysis, whereas haemodialysis was linked to lower concentrations of only NT-proBNP. At the end of dialysis, all three biomarker concentrations were lower with haemodiafiltration than with haemodialysis.

METHODOLOGY

• Researchers conducted a crossover trial to evaluate changes in cardiac biomarkers during high-flux haemodialysis and postdilution haemodiafiltration in clinically stable adults with end-stage kidney disease undergoing in-centre haemodialysis.
• All eligible patients had arteriovenous fistula access, the capacity to maintain a blood flow rate above 300 mL/min, and no acute cardiovascular disease.
• A total of 26 patients were randomly assigned to start with either high-flux haemodialysis or postdilution haemodiafiltration, followed by a washout period of 1-3 weeks before crossing over to the other modality. Of these, 23 patients (median age, 67 years; 61% men) were included in the final analysis, with 20 completing both dialysis sessions and three completing only one session.
• Blood samples were collected before dialysis, at intervals up to 240 minutes during dialysis, and 30 minutes post-dialysis to measure hs-cTnI, hs-cTnT, and NT-proBNP concentrations; spent dialysate was collected after 120 minutes of dialysis.
• Primary outcomes were the estimated change from baseline in hs-cTnI, hs-cTnT, and NT-proBNP concentrations during each modality and the estimated difference in these changes between the two modalities.

TAKEAWAY

• At the end of dialysis, haemodiafiltration led to a significant reduction in concentrations of both hs-cTnI (-7.7 ng/L) and hs-cTnT (-23.4 ng/L) from baseline (P < .001 for both), whereas haemodialysis had no significant effect on either biomarker.
• NT-proBNP concentrations were significantly reduced from baseline with both modalities by the end of dialysis (-2954 ng/L with haemodialysis and -5161 ng/L with haemodiafiltration; P < .001 for both).
• At the end of dialysis, all three biomarker concentrations were significantly lower with haemodiafiltration than with haemodialysis (P < .001 for all).

IN PRACTICE

"Our results show that 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," the authors wrote.

SOURCE

This study was led by Caroline Liboriussen Drivsholm, Aalborg University Hospital, Aalborg, Denmark. It was published online on July 20, 2026, in Kidney360.

LIMITATIONS

The study included only asymptomatic patients without acute cardiovascular disease. Continuous Holter monitoring and echocardiography were not performed during dialysis. Additionally, the method used to measure biomarkers in the spent dialysate had been validated only in blood.

DISCLOSURES

This study received funding from the Novo Nordisk Foundation, the Danish Kidney Association of the North Denmark Region, the Danish Society of Nephrology, and other sources. One author reported receiving speaking honoraria from CSL Vifor. Several authors reported having employment at Aalborg University Hospital.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.