The influence of hemodialysis membrane permeability on serum procalcitonin values in patients on maintenance hemodialysis.

Abstract

Procalcitonin (PCT) has emerged as a marker of infection and it could be useful for detection of systemic bacterial infections in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). The aim of this study was to assess the influence of HD membrane permeability to PCT serum levels in noninfected HD patients on maintenance HD. In a prospective comparative study, we measured PCT serum levels and C reactive protein (CRP) before and after HD in 36 sessions (18 sessions of HD with low-flux = Group L; and 18 sessions with high flux membranes = Group H), in 18 chronic HD patients without history of infection. Sessions of HD by high-flux membranes (Group H) displayed median PCT values that were significantly decreased after dialysis (0.21 ng/mL [0.13-0.41] vs. 0.18 ng/mL [0.10-0.24], p <0.001) but median PCT significantly increased after HD sessions by low-flux membranes (Group L) (0.21 ng/mL [0.14-0.33] vs. 0.25 ng/mL [0.14-0.36]; p = 0.008). CRP values were significantly increased after HD in both groups. CRP correlated with PCT values only in group H before HD (r = 0.49; p = 0.36). PCT represents a useful diagnostic marker for systemic bacterial infection. However, there is a need for specific reference ranges to be developed in patients with renal failure undergoing HD; also, PCT serum levels must be interpreted according to the HD membrane permeability.