Procalcitonin serum levels in children undergoing chronic haemodialysis

Abstract

Infections account for considerable morbidity and mortality in patients requiring haemodialysis (HD). Procalcitonin (PCT)-a low molecular weight protein of 13 kDa-helps one to distinguish viral from bacterial infections and to evaluate the severity of bacterial infections. We investigated (1) PCT baseline levels in eight children undergoing chronic HD with high-flux membranes and (2) changes in the serum levels of PCT, C-reactive protein (CRP) and beta-2-microglobulin (beta2-MG)-a peptide with biochemical characteristics similar to those of PCT-before and after haemodialysis sessions. Blood sampling was performed three times in the mid-week session. Serum PCT of the seven uninfected children before HD sessions was increased (0.75+/-0.07 ng/ml), whereas CRP levels were normal. PCT after dialysis decreased significantly by 40% (P<0.0001) compared with initial values, whereas CRP levels before and after HD were not different. beta2-MG decreased by 70%, probably due to different biochemical properties of both proteins. PCT serum levels 15 min and 60 min after the HD session remained unchanged in comparison with those at the end of the HD session, suggesting accumulation of PCT between HD sessions rather than HD-induced production to be responsible for the increased baseline PCT serum levels. We concluded that CRP serum levels were not affected by HD in our group. Moderately elevated baseline PCT serum levels that are presumably due to reduced renal clearance and uraemia and dialysis-ability of PCT should be taken into consideration. However, increase of serum PCT in patients with severe bacterial infections is generally massive (10-fold to 1,000-fold), suggesting a low risk for false negative results in such cases.

Plasma calprotectin in chronically dialyzed end-stage renal disease patients

“…Currently applied laboratory parameters for inflammation can be misleading-some of these parameters may be decreased, such as white blood cell count, and others may be non-specifically increased, such as erythrocyte sedimentation rate, C-reactive protein (CRP), or procalcitonin (PCT) [7][8][9]. In this study, we investigated plasma calprotectin as an inflammatory marker in chronically hemodialyzed ESRD patients.…”

Strong Correlation of B2-Microglobulin (B2-m) with Procalcitonin (PCT) in the Serum of Chronic Hemodialysis Patients: A Role for Infections in the Dialysis-Related Amyloidosis?

“…We must mention that increases of PCT are noticed in several non-infectious conditions, such as acute myocardial infarction, major surgery, burns, and shock, as well as in dialysis patients. [17,19,[26][27][28] Their influence on the results of our study must be small (if any exists at all), as most of these conditions are easily recognized and did not occur in our patients, and the referred increases are small (mostly less than the defined 1.5 ng/mL upper limit of normal for PCT).…”

Usefulness of serum procalcitonin as a diagnostic biomarker of infection in children with chronic kidney disease

“…According to Rahimzadeh et al [26], serum procalcitonin concentration is a sensitive and promising predictor of high-grade vesicoureteral reflux (VUR). Also, Lorton et al [27] concluded that increase of serum PCT in children with severe bacterial infections is mostly massive (10-fold to 1,000-fold), indicating a low risk for false negative results in these patients. Lastly, the study by Decaluwe et al [28] revealed that serum levels of PCT are associated with the severity of illness in children with diarrhea-associated hemolytic uremic syndrome.…”