Intensive Care Medicine

, Volume 29, Issue 4, pp 579–583 | Cite as

Procalcitonin and C-reactive protein plasma concentrations in nonseptic uremic patients undergoing hemodialysis

  • Ashraf A. Dahaba
  • Peter H. Rehak
  • Werner F. List



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.


Hemodialysis Intermittent renal replacement therapy Chronic renal failure Procalcitonin 


  1. 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. 2.
    Baily JL, Mitch WE (2000) Hemodialysis. In: Brenner BM (ed) The kidney. Saunders, Philadelphia, pp 2373–2453Google Scholar
  3. 3.
    Hakim RM, Lowrie EG (1982) Hemodialysis-associated neutropenia and hypoxemia: the effect of dialyzer membrane materials. Nephron 32:32–39PubMedGoogle Scholar
  4. 4.
    Le Moullec JM, Jullienne A, Chenais J, Lasmolas F, Guilana JM, Milhaud G, Moukhtar MS (1984) The complete sequence of human preprocalcitonin. FEBS Lett 167:93–97PubMedGoogle Scholar
  5. 5.
    Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C (1993) High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 341:515–518PubMedGoogle Scholar
  6. 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
  7. 7.
    Jacobs JW, Lund PK, Potts JT Jr, Bell NH, Habener JF (1981) Procalcitonin is a glycoprotein. J Biol Chem 256:2803–2807PubMedGoogle Scholar
  8. 8.
    Owen WF, Lowrie EG (1998) C-reactive protein as an outcome predictor for maintenance hemodialysis patients. Kidney Int 54:627–636CrossRefPubMedGoogle Scholar
  9. 9.
    Schmidt M, Burchardi C, Sitter T, Held E, Schiffl H (2000) Procalcitonin in patients undergoing chronic hemodialysis. Nephron 84:187–188PubMedGoogle Scholar
  10. 10.
    Moher D, Schultz KF, Altman DG, for the CONSORT group (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 357:1191–1194PubMedGoogle Scholar
  11. 11.
    American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874PubMedGoogle Scholar
  12. 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. 13.
    Bergstroem J, Wehle B (1987) No change in corrected β2-microglobulin concentration after curophane haemodialysis. Lancet I:628–629Google Scholar
  14. 14.
    De Vriese AS, Colardyn FA, Philippe JJ, Vanholder RC, De Sutter JH, Lameire NH (1999) Cytokine removal during continuous hemofiltration in septic patients. J Am Soc Nephrol 10:846–853PubMedGoogle Scholar
  15. 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
  16. 16.
    Al-Nawas B, Krammer I, Shah PM (1996) Procalcitonin in diagnosis of severe infections. Eur J Med Res 1:331–333PubMedGoogle Scholar
  17. 17.
    Herbelin A, Urena P, Nguyen AT, Zingraff J, Descamps-Latscha B (1991) Elevated circulating levels of interleukin-6 in patients with chronic renal failure. Kidney Int 39:954–960PubMedGoogle Scholar
  18. 18.
    Herbelin A, Nguyen AT, Zingraff J, Urena P, Descamps-Latscha B (1990) Influence of uremia and hemodialysis on circulating interleukin-1 and tumor necrosis factor α. Kidney Int 37:116–125PubMedGoogle Scholar
  19. 19.
    Bone RC (1991) The pathogenesis of sepsis. Ann Intern Med 115:457–469PubMedGoogle Scholar
  20. 20.
    Monneret G, Laroche B, Bienvenu J (1999) Procalcitonin is not produced by circulating blood cells. Infection 27:34–35PubMedGoogle Scholar
  21. 21.
    Nijsten MW, Olinga P, The TH, de Vries EG, Koops HS, Groothuis GM, Limburg PC, ten Duis HJ, Moshage H, Hoekstra HJ, Bijzet J, Zwaveling JH (2000) Procalcitonin behaves as a fast responding acute phase protein in vivo and in vitro. Crit Care Med 28:458–461PubMedGoogle Scholar
  22. 22.
    Hakim RM (1993) Clinical implications of hemodialysis membrane biocompatibility. Kidney Int 44:484–494PubMedGoogle Scholar
  23. 23.
    Dandona P, Nix D, Wilson MF, Aljada A, Love J, Assicot M, Bohuon C (1994) Procalcitonin increases after endotoxin injection in normal subjects. J Clin Endocrinol Metab 79:1605–1608PubMedGoogle Scholar
  24. 24.
    Meisner M, Lohs T, Huettemann E, Schmidt J, Hueller M, Reinhart K (2001) The plasma elimination rate and urinary secretion of procalcitonin in patients with normal and impaired renal function. Eur J Anaesthesiol 18:79–87PubMedGoogle Scholar
  25. 25.
    Zimmermann J, Herrlinger S, Pruy A, Metzger T, Wanner C (1999) Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney Int 55:648–658CrossRefPubMedGoogle Scholar
  26. 26.
    Herget-Rosenthal S, Marggraf G, Pietruck F, Huessing J, Strupat M, Philipp T, Kribben A (2001) Procalcitonin for accurate detection of infection in haemodialysis. Nephrol Dial Transplant 16:975–979CrossRefPubMedGoogle Scholar
  27. 27.
    Dahaba AA, El-Awady GA, Rehak PH, List WF (2002) Procalcitonin and proinflammatory cytokines clearance during continuous venovenous haemofiltration in septic patients. Anaesth Intensive Care 30:269–274PubMedGoogle Scholar
  28. 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
  29. 29.
    Meisner M, Huettemann E, Lohs T, Kasakov L, Reinhart K (2001). Elimination of procalcitonin and plasma concentrations during continuous veno-venous hemodiafiltration in septic patients. Eur J Anaesthesiol 17:665–671CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Ashraf A. Dahaba
    • 1
  • Peter H. Rehak
    • 2
  • Werner F. List
    • 1
  1. 1.Department of Anaesthesiology and Intensive Care MedicineKarl Franzens UniversityGrazAustria
  2. 2.Department of Surgery, Biomedical Engineering and Computing UnitKarl Franzens UniversityGrazAustria

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