title: Procalcitonin for accurate detection of infection in haemodialysis.
abstract: BACKGROUND
  Infection results in considerable morbidity and mortality in haemodialysis patients. Diagnosis of infection can be difficult because currently applied laboratory parameters may be non-specifically altered due to uraemia or haemodialysis (HD). This study investigated the diagnostic value and kinetics of serum procalcitonin (PCT), a low-molecular-weight protein, in patients receiving intermittent HD.
  
  
  METHODS
  Sixty-eight patients receiving intermittent HD for end-stage renal disease (n=48) or acute renal failure (n=20) were prospectively studied, 47 treated with high-flux and 21 with low-flux membranes. Of 36 patients with severe infections or sepsis, 27 were treated with high-flux and nine with low-flux membranes. WBC, serum PCT and C-reactive protein (CRP) concentrations were measured immediately before HD, and PCT repeatedly during the following 48 h.
  
  
  RESULTS
  When determined immediately before HD, PCT demonstrated a sensitivity of 89%, a specificity of 81%, and positive and negative predictive values of 84 and 87%, indicating severe infection or sepsis. These levels were higher than the respective values for CRP (89, 48, 68 and 78%) and WBC (58, 75, 71 and 59%). After 4 h of HD with high-flux membranes, PCT decreased significantly to 83+/-25% and did not return to predialysis concentrations before 48 h. This decrease in serum PCT resulted in markedly reduced sensitivity (65%) and negative predictive value (54%). In contrast, no marked change in PCT concentration occurred during or after HD with low-flux membranes.
  
  
  CONCLUSIONS
  Serum PCT is an accurate indicator of severe infection and sepsis in patients receiving intermittent HD. High-flux membranes substantially decrease PCT. When utilizing high flux membranes, serum PCT concentrations should be determined prior to the start of HD.
authors.affiliation: Division of Nephrology, University Hospital, University of Essen, D-45122 Essen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Herget-Rosenthal
authors.forename: G
authors.initials: G
authors.lastname: Marggraf
authors.forename: F
authors.initials: F
authors.lastname: Pietruck
authors.forename: J
authors.initials: J
authors.lastname: Hüsing
authors.forename: M
authors.initials: M
authors.lastname: Strupat
authors.forename: T
authors.initials: T
authors.lastname: Philipp
authors.forename: A
authors.initials: A
authors.lastname: Kribben
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy; D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006801:Humans; D007239:Infections / Q000097:blood / Q000175:diagnosis* / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000628:therapy; D007958:Leukocyte Count; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D006435:Renal Dialysis / Q000009:adverse effects*; D012680:Sensitivity and Specificity
chemical_list: C000606589:CALCA protein, human; D008567:Membranes, Artificial; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide