Evaluation of ischaemia-modified albumin as a marker of myocardial ischaemia in end-stage renal disease.

The early diagnosis of myocardial ischaemia is problematic in patients with ESRD (end-stage renal disease). The aim of the present study was to determine whether IMA (ischaemia-modified albumin) increases during dobutamine stress and detects myocardial ischaemia in patients with ESRD. A total of 114 renal transplant candidates were studied prospectively, and all received DSE (dobutamine stress echocardiography). IMA levels were taken at baseline and I h after cessation of DSE. A total of 35 patients (31 %) had a positive DSE result. Baseline IMA levels were not significantly different in the DSE-positive and -negative groups. The increase in IMA was significantly higher in the DSE-positive group compared with those with no ischaemic response (26.5 ± 19.1 compared with 8.2 ±9.6 kU/I respectively; P= 0.007; where kU is kilo-units). From ROC (receiver operator charactertistic) curve analysis, the optimal IMA increase to predict an ischaemic response was 20 kU/I, with a sensitivity of 81 % and a specificity of 72% [area under the curve, 0.80 (95% confidence interval, 0.44-0.94); P= 0.03]. There were 18 deaths, ten of which were cardiac in nature over a follow up period of 2.25 + 0.71 years. An increase in IMA ≥ 20 kU/I was associated with significantly worse survival (P=0.02). In conclusion, IMA is a moderately accurate marker of myocardial ischaemia in ESRD. Patients with an increase in IMA ≥ 20 kU/I during DSE had significantly worse survival.