Skip to main content
Erschienen in: Intensive Care Medicine 4/2003

01.04.2003 | Original

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

verfasst von: Ashraf A. Dahaba, Peter H. Rehak, Werner F. List

Erschienen in: Intensive Care Medicine | Ausgabe 4/2003

Einloggen, um Zugang zu erhalten

Abstract

Objective

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.

Patients

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.

Interventions

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.

Conclusions

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.
Literatur
1.
Zurück zum Zitat 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]:11–12 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]:11–12
2.
Zurück zum Zitat Baily JL, Mitch WE (2000) Hemodialysis. In: Brenner BM (ed) The kidney. Saunders, Philadelphia, pp 2373–2453 Baily JL, Mitch WE (2000) Hemodialysis. In: Brenner BM (ed) The kidney. Saunders, Philadelphia, pp 2373–2453
3.
Zurück zum Zitat Hakim RM, Lowrie EG (1982) Hemodialysis-associated neutropenia and hypoxemia: the effect of dialyzer membrane materials. Nephron 32:32–39PubMed Hakim RM, Lowrie EG (1982) Hemodialysis-associated neutropenia and hypoxemia: the effect of dialyzer membrane materials. Nephron 32:32–39PubMed
4.
Zurück zum Zitat Le Moullec JM, Jullienne A, Chenais J, Lasmolas F, Guilana JM, Milhaud G, Moukhtar MS (1984) The complete sequence of human preprocalcitonin. FEBS Lett 167:93–97PubMed Le Moullec JM, Jullienne A, Chenais J, Lasmolas F, Guilana JM, Milhaud G, Moukhtar MS (1984) The complete sequence of human preprocalcitonin. FEBS Lett 167:93–97PubMed
5.
Zurück zum Zitat Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C (1993) High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 341:515–518PubMed Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C (1993) High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 341:515–518PubMed
6.
Zurück zum Zitat 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 26:1001–1006 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 26:1001–1006
7.
Zurück zum Zitat Jacobs JW, Lund PK, Potts JT Jr, Bell NH, Habener JF (1981) Procalcitonin is a glycoprotein. J Biol Chem 256:2803–2807PubMed Jacobs JW, Lund PK, Potts JT Jr, Bell NH, Habener JF (1981) Procalcitonin is a glycoprotein. J Biol Chem 256:2803–2807PubMed
8.
Zurück zum Zitat Owen WF, Lowrie EG (1998) C-reactive protein as an outcome predictor for maintenance hemodialysis patients. Kidney Int 54:627–636CrossRefPubMed Owen WF, Lowrie EG (1998) C-reactive protein as an outcome predictor for maintenance hemodialysis patients. Kidney Int 54:627–636CrossRefPubMed
9.
Zurück zum Zitat Schmidt M, Burchardi C, Sitter T, Held E, Schiffl H (2000) Procalcitonin in patients undergoing chronic hemodialysis. Nephron 84:187–188PubMed Schmidt M, Burchardi C, Sitter T, Held E, Schiffl H (2000) Procalcitonin in patients undergoing chronic hemodialysis. Nephron 84:187–188PubMed
10.
Zurück zum Zitat 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 357:1191–1194PubMed 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 357:1191–1194PubMed
11.
Zurück zum Zitat 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 20:864–874PubMed 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 20:864–874PubMed
12.
Zurück zum Zitat 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–S66 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–S66
13.
Zurück zum Zitat Bergstroem J, Wehle B (1987) No change in corrected β2-microglobulin concentration after curophane haemodialysis. Lancet I:628–629 Bergstroem J, Wehle B (1987) No change in corrected β2-microglobulin concentration after curophane haemodialysis. Lancet I:628–629
14.
Zurück zum Zitat 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 10:846–853PubMed 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 10:846–853PubMed
15.
Zurück zum Zitat 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 40:1250–1256PubMed 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 40:1250–1256PubMed
16.
Zurück zum Zitat Al-Nawas B, Krammer I, Shah PM (1996) Procalcitonin in diagnosis of severe infections. Eur J Med Res 1:331–333PubMed Al-Nawas B, Krammer I, Shah PM (1996) Procalcitonin in diagnosis of severe infections. Eur J Med Res 1:331–333PubMed
17.
Zurück zum Zitat 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 39:954–960PubMed 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 39:954–960PubMed
18.
Zurück zum Zitat 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 37:116–125PubMed 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 37:116–125PubMed
19.
Zurück zum Zitat Bone RC (1991) The pathogenesis of sepsis. Ann Intern Med 115:457–469PubMed Bone RC (1991) The pathogenesis of sepsis. Ann Intern Med 115:457–469PubMed
20.
Zurück zum Zitat Monneret G, Laroche B, Bienvenu J (1999) Procalcitonin is not produced by circulating blood cells. Infection 27:34–35PubMed Monneret G, Laroche B, Bienvenu J (1999) Procalcitonin is not produced by circulating blood cells. Infection 27:34–35PubMed
21.
Zurück zum Zitat 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 28:458–461PubMed 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 28:458–461PubMed
22.
Zurück zum Zitat Hakim RM (1993) Clinical implications of hemodialysis membrane biocompatibility. Kidney Int 44:484–494PubMed Hakim RM (1993) Clinical implications of hemodialysis membrane biocompatibility. Kidney Int 44:484–494PubMed
23.
Zurück zum Zitat 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 79:1605–1608PubMed 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 79:1605–1608PubMed
24.
Zurück zum Zitat 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 18:79–87PubMed 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 18:79–87PubMed
25.
Zurück zum Zitat Zimmermann J, Herrlinger S, Pruy A, Metzger T, Wanner C (1999) Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney Int 55:648–658CrossRefPubMed Zimmermann J, Herrlinger S, Pruy A, Metzger T, Wanner C (1999) Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney Int 55:648–658CrossRefPubMed
26.
Zurück zum Zitat 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 16:975–979CrossRefPubMed 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 16:975–979CrossRefPubMed
27.
Zurück zum Zitat 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 30:269–274PubMed 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 30:269–274PubMed
28.
Zurück zum Zitat 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 15:171–175 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 15:171–175
29.
Zurück zum Zitat 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 17:665–671CrossRef 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 17:665–671CrossRef
Metadaten
Titel
Procalcitonin and C-reactive protein plasma concentrations in nonseptic uremic patients undergoing hemodialysis
verfasst von
Ashraf A. Dahaba
Peter H. Rehak
Werner F. List
Publikationsdatum
01.04.2003
Verlag
Springer-Verlag
Erschienen in
Intensive Care Medicine / Ausgabe 4/2003
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-003-1664-8

Weitere Artikel der Ausgabe 4/2003

Intensive Care Medicine 4/2003 Zur Ausgabe

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.