Procalcitonin as an inflammatory marker in comparison between high-flux and low-flux hemodialysis in patients with end-stage renal disease

Abstract

Background Although procalcitonin (PCT) has been described as a new marker of infection and inflammation, it has not been extensively studied in hemodialysis (HD) patients. Patients and methods We measured PCT serum levels and high-sensitivity C-reactive protein (hs-CRP) before and immediately after HD in 50 adult HD patients (25 treated with high-flux membranes and 25 with low-flux membranes), without history of concurrent infections. Results The baseline PCT levels before HD were higher than healthy individuals. There was a highly significant decrease in PCT serum levels after HD session in patients undergoing HD by high-flux membranes but not by low-flux membranes (high flux 0.54 ng/ml pre-HD vs. 0.26 ng/ml post-HD, P=0.001, whereas in low flux 0.50 ng/ml vs. 0.53 ng/ml, P=0.066). Hs-CRP levels were unchanged in both groups. There was no correlation between PCT and CRP. Conclusion Although PCT is considered a sensitive and specific diagnostic and prognostic marker of systemic bacterial infection, we suggest that specific reference ranges might be developed in patients with impaired renal function; moreover, its clinical usefulness might be limited in patients undergoing HD with high-flux membranes.