Procalcitonin and C-reactive protein plasma concentrations in nonseptic uremic patients undergoing hemodialysis
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To assess procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations and clearance in nonseptic end-stage renal failure patients undergoing their first three hemodialysis sessions.
Design and setting
Prospective observational consecutive clinical study at a university hospital.
The study recruited 55 end-stage renal failure patients without evidence of systemic infection undergoing the creation of an arteriovenous fistula to start hemodialysis for the first time.
Blood samples were collected before and after each of the first three (4–5 h) hemodialysis sessions. PCT was assayed by immunoluminometry.
Measurements and results
The mean plasma concentration of PCT prior to the first three hemodialysis sessions declined significantly following each session. There was no significant difference between CRP plasma concentrations before and after hemodialysis sessions.
The presence of an elevated PCT in plasma of not yet dialyzed uremic nonseptic patients indicates that uremia per se and not the dialysis process is the origin of such elevation. PCT levels declined with successive hemodialysis sessions. We propose that in the not yet dialyzed uremic nonseptic patients a baseline PCT level of approx. 1.5 ng/ml should be expected. Although the mean plasma CRP level was elevated, hemodialysis had no significant effect on CRP concentration, making CRP a possible useful marker of sepsis in these patients.
KeywordsHemodialysis Intermittent renal replacement therapy Chronic renal failure Procalcitonin
- 1.European Renal Association European-Dialysis and Transplant Association (ERA-EDTA) report on management of renal failure in Europe (1995) Causes of death. Nephrol Dial Transplant 10 [Suppl 5]:11–12Google Scholar
- 2.Baily JL, Mitch WE (2000) Hemodialysis. In: Brenner BM (ed) The kidney. Saunders, Philadelphia, pp 2373–2453Google Scholar
- 6.Nylen ES, Whang KT, Snider RH Jr, Steinwald PM, White JC, Becker KL (1998) Mortality is increased by procalcitonin and decreased by an antiserum reactive to procalcitonin in experimental sepsis. Crit Care Med 26:1001–1006Google Scholar
- 12.National Kidney Foundation-Dialysis Outcome Quality Initiative clinical practice guidelines for hemodialysis adequacy (1997) National Kidney Foundation-Dialysis Outcomes Quality Initiative Am J Kidney Dis 30 [4 Suppl 3]:S15–S66Google Scholar
- 13.Bergstroem J, Wehle B (1987) No change in corrected β2-microglobulin concentration after curophane haemodialysis. Lancet I:628–629Google Scholar
- 15.Eberhard OK, Haubitz M, Brunkhorst FM, Kliem V, Koch KM, Brunkhorst R (1997) Usefulness of Procalcitonin for differentiation between activity of systemic autoimmune disease (systemic lupus erythematosus /systemic antineutrophil cytoplasmic antibody-associated vasculitis) and invasive bacterial infection. Arthritis Rheum 40:1250–1256PubMedGoogle Scholar
- 28.Meisner M, Huettemann E, Lohs T, Kasakov L, Reinhart K (2001). Plasma concentrations and clearance of procalcitonin during continuous veno-venous hemofiltration in septic patients. Shock 15:171–175Google Scholar