Elimination of procalcitonin and plasma concentrations during continuous veno-venous haemodiafiltration in septic patients.
The elimination of procalcitonin and the course of plasma concentrations during continuous veno-venous haemodiafiltration were measured in patients with sepsis or multiple organ dysfunction syndrome, because these patients are a main target group for the measurement of procalcitonin and often require renal replacement therapy. Procalcitonin was measured in the prefilter plasma and the filtrate at 5 min, 15 min and 1, 2, 4, 6, 12, 24 h after set-up of continuous veno-venous haemodiafiltration. In a prospective study, 19 patients with plasma levels of procalcitonin > 3 ng mL-1 and acute oliguric renal failure treated with continuous veno-venous haemodiafiltration using a polysulphone membrane, were evaluated for the study of clearance. Twenty-one control patients (procalcitonin < 2 ng mL-1) were studied to determine whether filtration itself induced a procalcitonin response. No interventions were required. In patients with low procalcitonin concentrations (procalcitonin < 2 ng mL-1) continuous veno-venous haemodiafiltration did not cause a rise in procalcitonin. In patients with increased procalcitonin plasma concentrations (> 3 ng mL-1), the protein was removed through the polysulphone membrane, with a final clearance of 4 mL min-1 after the initial adsorption period (clearance 0.4-0.9 mL min-1 during the first hour of continuous veno-venous haemodiafiltration). Thus, on the average, approximately 10% of plasma concentrations were measurable in the filtrate ultimately. However, procalcitonin plasma levels were not significantly altered during continuous veno-venous haemodiafiltration (86% of the initial concentration after 24 h). Although procalcitonin is removed from the plasma during continuous veno-venous haemodiafiltration in measurable amounts plasma procalcitonin concentrations did not change significantly during haemodiafiltration. Procalcitonin thus can also be used as a diagnostic parameter in patients undergoing continuous veno-venous haemodiafiltration.
Meisner
M
M
Departments of Anaesthesiology and Intensive Care Therapy and General and Visceral Surgery, University of Jena, Bachstr. 18, D-07743 Jena, Germany.
Hüttemann
E
E
Lohs
T
T
Kasakov
L
L
Reinhart
K
K
D058186:Acute Kidney Injury / Q000097:blood / Q000378:metabolism / Q000628:therapy; D000327:Adsorption; D000368:Aged; D001672:Biocompatible Materials; D002116:Calcitonin / Q000097:blood / Q000493:pharmacokinetics*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D005500:Follow-Up Studies; D006023:Glycoproteins / Q000097:blood / Q000493:pharmacokinetics*; D017583:Hemodiafiltration / Q000295:instrumentation; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000378:metabolism / Q000628:therapy; D011108:Polymers; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood / Q000493:pharmacokinetics*; D017582:Renal Replacement Therapy; D018805:Sepsis / Q000097:blood / Q000378:metabolism / Q000628:therapy*; D012772:Shock, Septic / Q000097:blood / Q000378:metabolism / Q000628:therapy; D018709:Statistics, Nonparametric; D013450:Sulfones
D001672:Biocompatible Materials; C000606589:CALCA protein, human; D006023:Glycoproteins; D008567:Membranes, Artificial; D011108:Polymers; D011498:Protein Precursors; D013450:Sulfones; C017662:polysulfone P 1700; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide