BACKGROUND: The aim of this study was to investigate the prevalence and clinical significance of abnormal values of cardiac markers, high sensitivity CRP (hsCRP) and homocysteine occurring in hemodialysis patients without clinical evidence of acute coronary ischemia. METHODS: We determined the concentrations of cardiac troponin T (cTnT), troponin I (cTnI), creatine kinase MB (CK-MB), myoglobin, hsCRP, homocysteine and other biochemical parameters 35 patients with chronic renal failure (CRF) and 22 healthy controls. All CRF patients were followed in for 3 years. RESULTS: All of the measured parameters except cholesterol were significantly elevated in the patients, comparing with controls (P<0.01). The numbers with elevated values above cutoff levels in CK-MB, cTnT, cTnI and hsCRP did not show any significant differences between the two groups (P>0.05). A good association was present between cTnT and CK-MB, cTnT and myoglobin, myoglobin and creatinine, and BUN and creatinine. Inquiries about underlying diseases of CRF revealed that diabetes mellitus group showed significantly higher cTnT values than in hypertension group or inflammation group. cTnT was elevated above cutoff value in about 17% of patients, while cTnI was in none of them. During one-year follow-up period, 6 patients (18.2%) died and 3 of them had initially elevated cTnT values. Four patients had cardiac events, but none of them had any increase in the values of the cardiac markers. The patients with increased cTnT values above cutoff value (> or =0.1 ng/ mL) showed a significantly higher mortality rate than the patients with cTnT values below the cutoff value in 3-year follow-up (P<0.05). CONCLUSIONS: Mildly elevated cardiac markers, hsCRP and homocysteine are common in CRF patients undergoing hemodialysis. It is recommended that cTnI values be used for diagnosis of ischemic heart disease in CRF patients. The three-year follow-up outcome suggests that cTnT is a potential prognostic marker of mortality in CRF patients.