calca-protein--human and Kidney-Failure--Chronic

Topics: Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Carcinoma, Medullary; Humans; Hypercalcemia; Hypocalcemia; Immunoradiometric Assay; Inflammation; Kidney Failure, Chronic; Luminescent Measurements; Osteoporosis; Protein Precursors; Radioimmunoassay; Reference Values; Sepsis; Thyroid Neoplasms

Cardiovascular diseases and infections remain the first mortality causes in ESRD patients. European recommendations for good clinical practice in the hemodialysis field advocate to use the inflammation markers in daily practice. These markers foretell both cardiovascular and global mortality. They also enable to detect the silent infections (parodontitis, Heliobacter pilory infection, shunt infection in PTFE), to make sure of the dialysis biocompatibility (microbiological quality of the dialysate, use of biocompatible membrane). The C-reactive protein is the most current and used marker. Its use, combined with the procalcitonin measurement, specific marker for bacterial infection, would enable the diagnostic and therapeutic strategy improvement.

Topics: Biomarkers; Blood Sedimentation; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cardiovascular Diseases; Decision Trees; Fibrinogen; Glycoproteins; Humans; Inflammation; Kidney Failure, Chronic; Protein Precursors; Renal Dialysis

to determine the effect of oral N-acetylcysteine (NAC) on plasma levels of inflammatory markers in Continuous Ambulatory Peritoneal Dialysis (CAPD) patients.. we performed a placebo-controlled study over 8 weeks in 32 patients on regular CAPD. The patients were divided into 2 groups of 16 patients matched for age and gender. The first group was given NAC 2x600 mg/day for 8 weeks and inflammatory parameter was compared with control group. The immune system is determined from the average levels of Procalcitonin, IL-6, IL-1, C3, SICAM, hsCRP, and TNF- before and after treatment with NAC. Student t-test was performed to compare the means between NAC receiving and control groups. All statistics were done using SPSS software (SPSS Ver 16.0).. administration of NAC, significantly diminished PCT (-0.38±0.57 vs 0.09±0.14; p=0.004), IL-6 (-1.94±3.03 vs 1.19±1.99; p=0.002), IL-1 (-0.14±0.21 vs 0.01±0.04; p=0.010), C3 (-7.40±12.04 vs 4.60±8.12; p=0.002), sICAM (-80.59±29.18 vs -35.02±46.99; p=0.007), hsCRP (-1.50±1.32 vs 0.81±1.17; p<0.001) and TNF- (-0.73±0.47 vs 0.14±0.74; p<0.001) levels compared control to group.. short-term oral NAC treatment resulted in reduction of circulating PCT, IL-6, IL-1, C3, sICAM, hsCRP, and TNF- in CAPD patients.

Topics: Acetylcysteine; Adult; Antioxidants; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Complement C3; Female; Humans; Inflammation; Interleukin-1; Interleukin-6; Kidney Failure, Chronic; Male; Middle Aged; Oxidative Stress; Peritoneal Dialysis, Continuous Ambulatory; Protein Precursors; Tumor Necrosis Factor-alpha

Presepsin is a useful marker for differentiating sepsis from non-infection-related systemic inflammatory response syndrome. There are data describing elevated presepsin concentrations in patients with kidney dysfunction even in the absence of sepsis, but corresponding data for patients with end-stage kidney disease (ESKD) undergoing living kidney transplantation (LKT) are lacking. We investigated the changes in presepsin concentrations in this patient group in order to elucidate any relationship with renal function. Written informed consent was obtained from patients with ESKD requiring hemodialysis who underwent LKT from June 2014 through March 2015 at Hirosaki University Hospital. Patients with obvious signs of infection were excluded. Perioperative presepsin and procalcitonin concentrations were measured before induction of anesthesia, on admission to the intensive care unit after surgery, and on postoperative day (POD) 1 and POD 2. Preoperative presepsin concentration was markedly higher than the upper limit of normal in patients with ESKD (1252 ± 451 pg/mL). Presepsin concentrations consistently decreased after LKT. Moreover, presepsin concentration was strongly correlated with serum creatinine (r (2) = 0.72, n = 24, p < 0.001). These data suggest that the kidney clearly plays an important role in the metabolism and excretion of presepsin.

Topics: Adult; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Intensive Care Units; Kidney Failure, Chronic; Kidney Function Tests; Kidney Transplantation; Lipopolysaccharide Receptors; Male; Middle Aged; Peptide Fragments; Pilot Projects; Protein Precursors; Sepsis

Serum procalcitonin (PCT) levels are low in healthy individuals but are elevated in patients with a serious bacterial infection or sepsis. In this study, we examined the ability of serum PCT concentration to diagnose infections in end-stage renal disease (ESRD) patients, and sought to determine an appropriate threshold level.. Serum PCT levels were measured in ESRD patients on antibiotic therapy for a suspected bacterial infection (ESRD infection [iESRD] group, n = 21), and compared with those of ESRD patients on hemodialysis with no sign of infection (ESRD control [cESRD] group, n = 20).. The mean serum PCT concentration of the iESRD group was significantly higher than in the cESRD group (2.95 ± 3.67 ng/mL vs. 0.50 ± 0.49 ng/mL, p = 0.006), but serum PCT concentrations did not correlate with severity of infection. The optimized threshold level derived for serum PCT was 0.75 ng/mL, rather than the currently used 0.5 ng/mL; this threshold demonstrated a sensitivity and specificity of 76.2% and 80.0% for infection and 100% and 60.6% for systemic inflammatory response syndrome, respectively, compared with the cutoff of 0.5 ng/mL.. This study suggests that serum PCT at a cutoff value of 0.75 ng/mL is an appropriate indicator of infection in ESRD patients.

Topics: Adult; Aged; Area Under Curve; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Female; Humans; Inflammation Mediators; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis; Predictive Value of Tests; Protein Precursors; Renal Dialysis; Reproducibility of Results; ROC Curve; Up-Regulation

Although procalcitonin (PCT) has been described as a marker of infection and inflammation, it has not been extensively studied in patients with chronic kidney disease (CKD), end stage renal disease, or renal transplant.. PCT was routinely tested in 82 (56 dialyzed patients and 28 renal transplant recipients) consecutive cases with a strong clinical suspicion of infection, during a 6-month period, in a single referral unit.. During the study period, 58/82 cases had confirmed infections as per definition. Patients with confirmed infections had higher values for PCT [median = 2.5 ng/mL, interquartile range (IR) = 0.9-5 ng/mL] than those without (median = 0.3 ng/mL, IR = 0.1-0.5 ng/mL), p < 0.001. Overall, for a cutoff value of 0.5 ng/mL, the sensitivity of the test was 93.1 % and the specificity 78.6.. Our data indicate that significantly elevated PCT concentrations offer good sensitivity and specificity for the early diagnosis of systemic bacterial infection in patients with CKD.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Area Under Curve; Arteriovenous Shunt, Surgical; Bacteremia; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Enterocolitis; Female; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Peritoneal Dialysis; Peritonitis; Pneumonia, Bacterial; Protein Precursors; Pyelonephritis; ROC Curve; Young Adult

Procalcitonin (PCT) has emerged as a marker of infection, a frequent complication in hemodialysis (HD). We analyzed PCT levels in chronic non-acutely infected HD subjects, assessed its correlation with inflammatory and nutritional markers and propose a PCT reference value for non-infected HD patients. In an observational cross-sectional study, 48 chronic HD patients and 36 controls were analyzed.. age, gender, time on HD; diabetes; vascular access, PCT, C-reactive protein (CRP), albumin, malnutrition inflammatory score (MIS), hematocrit, leukocyte count, and body mass index (BMI). Subsequently, control (G1, n = 36, 43%) vs. non-infected patients (G2, n = 48, 57%) groups were compared. In control subjects (G1), age: 54.3 ± 13.7 years, range (r): 30-81; males: 19 (53%); median PCT 0.034 ng/ml (r: 0.02-0.08); median CRP 0.80 mg/ dl (r: 0.36-3.9); p95 PCT level: 0.063 ng/ml. In G2, age: 60.2 ± 15.2 years; males 32 (67%), time on HD: 27.0 ± 24.4; diabetics: 19 (32%); median PCT: 0.26 ng/ml (r: 0.09-0.82); CRP: 1.1 mg/dl (r: 0.5-6.2); p95 PCT level: 0.8 ng/ml. In control subjects, PCT and CRP were significantly lower than in G2: PCT: 0.034 vs. 0.26 ng/ml, p = 0.0001; CRP: 0.8 vs. 1.1 mg/dl, p = 0.0004. PCT-CRP correlation in G2: p = 0.287, p = 0.048. PCT and CRP concentrations are elevated in chronic non-acutely infected HD subjects, independently of infection, diabetes and vascular access. A p95 PCT level of 0.8 ng/ml may be considered as the upper normal reference value in non-acutely infected HD subjects. The PCT cut-off level in HD is yet to be determined in HD.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Bacterial Infections; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Cross-Sectional Studies; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Nutritional Status; Predictive Value of Tests; Protein Precursors; Reference Values; Renal Dialysis; Sex Factors; Time Factors; Vasculitis

In this study, we compared changes in inflammatory markers-C-reactive protein (CRP), pentraxin 3 (PTX3), serum component of amyloid A (SAA), and procalcitonin (PCT)-in 182 subjects: 69 from the general population (GP), 47 with CKD, 19 with an implanted intra-abdominal catheter for peritoneal dialysis ("prePD"), and 47 on peritoneal dialysis (PD). These were the results [median (95% confidence interval)] for the GP CKD, prePD, and PD groups respectively: CRP: 1.40 mg/L (1.15-2.10 mg/L), 5.30 mg/L (3.04-8.06 mg/L), 3.33 mg/L (2.15-12.58 mg/L), 7.25 mg/L (4.43-15.16 mg/L). SAA: 3.10 mg/L (2.90-3.53 mg/L), 7.77 mg/L (4.17-15.83 mg/L), 7.30 mg/L (4.81-10.96 mg/L), 9.14 mg/L (5.31-23.54 mg/L). PCT: 0.028 ng/mL (0.022-0.032 ng/mL), 0.121 ng/mL (0.094-0.166 ng/mL), 0.160 ng/mL (0.090-0.277 ng/mL), 0.363 ng/mL (0.222-0.481 ng/mL). PTX3: 0.54 ng/mL (0.33-0.62 ng/mL), 0.71 ng/ mL (0.32-1.50 ng/mL), 0.56 ng/mL (0.44-1.00 ng/ mL), 1.04 ng/mL (0.65-1.56 ng/mL). After catheter insertion, CRP showed a nonsignificant declining trend that disappeared throughout PD. The behavior of SAA was similar to that of CRP and was not modified by the changes induced by the start of PD. An increase in PTX3 was observed only with PD, which may be related to a local proinflammatory state caused by PD solution. We can conclude that catheter insertion for PD does not account for most of the local inflammatory changes observed in PD patients.

Topics: Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Inflammation; Kidney Failure, Chronic; Peritoneal Dialysis; Protein Precursors; Serum Amyloid A Protein; Serum Amyloid P-Component

Chronic kidney disease (CKD) is associated with a proinflammatory state and an excess of cardiovascular risk. In this work, we describe changes in inflammatory markers-C-reactive protein (CRP), pentraxin 3 (PTX3), serum component of amyloid A (SAA), and procalcitonin (PCT)--in CKD patients compared with a control group of subjects with a normal estimated glomerular filtration rate (eGFR). Blood samples were obtained from 69 healthy individuals (GP) and 70 end-stage CKD patients--25 not yet on dialysis, 22 on peritoneal dialysis (PD), and 23 on hemodialysis (HD). These were the results [median (95% confidence interval)] for the GP CKD, PD, and HD groups respectively: CRP: 1.40 mg/L (1.19-2.11 mg/L), 6.50 mg/L (3.57-8.32mg/L), 7.60 mg/L (2.19-22.10mg/L), 9.60 mg/L (6.62-16.38 mg/L). SAA: 3.10 mg/L (2.90-3.53 mg/L), 7.11 mg/L (3.81-15.40mg/L), 9.69 mg/L (5.07-29.47mg/L), 15.90 mg/L (6.80-37.48 mg/L). PCT: 0.03 ng/mL (0.02-0.03 ng/mL), 0.12 ng/mL (0.09-0.16 ng/mL), 0.32 ng/mL (0.20-0.46 ng/ mL), 0.79 ng/mL (0.45-0.99 ng/mL). PTX3: 0.54 ng/mL (0.33-0.62 ng/mL), 0.71 ng/ mL (0.32-1.50 ng/mL), 1.52 ng/mL (0.65-2.13 ng/mL), 1.67 ng/mL (1.05-2.27 ng/mL). Compared with levels in the GP group, levels of SAA and CRP (systemic response) were significantly higher in CKD patients on and not on dialysis. Levels of PTX3 were higher only in dialyzed patients, significantly so in those on HD (greatly different from the CRP levels). These differing levels might be related to a local reaction caused by an invasive intervention (PD or HD). As eGFR declines and with the start of renal replacement therapy, PCT increases. Levels of PCT could potentially cause confusion when these patients are being evaluated for the presence of infection, and may also demonstrate some microvascular implications of dialysis therapy.

Topics: Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Inflammation; Kidney Failure, Chronic; Peritoneal Dialysis; Protein Precursors; Renal Dialysis; Serum Amyloid A Protein; Serum Amyloid P-Component

The current study aimed to evaluate plasma calprotectin levels and clearance end-stage renal disease (ESRD) patients with and without acute infection undergoing chronic hemodialysis (HD).. Blood samples from 54 HD patients were obtained before and after the HD and 42 healthy blood donors were examined as controls. The blood levels of calprotectin, procalcitonin, C-reactive protein (CRP), and intracellular production of interleukins 10 and 12 in monocytes were determined in both groups.. The concentrations of plasma calprotectin in ESRD patients were significantly higher than in healthy controls (p < 0.05). No differences between pre- and post-HD calprotectin plasma levels were observed (p = 0.07 for two-tailed test). Plasma calprotectin levels were not significantly influenced by the presence of acute infection (p = 0.19) or diabetes (p = 0.42). A significant positive correlation of plasma calprotectin to plasma beta-2 microglobulin was proven (p < 0.05). Procalcitonin (PCT), CRP, IL-10, and IL-12 were not correlated with plasma calprotectin before or after HD. The elevation of plasma calprotectin was correlated strongly to the hemodialysis vintage (r = 0.55, p < 0.01).. Significantly elevated levels of plasma calprotectin in ESRD patients occur without an acute infectious cause and are not affected by the presence of diabetes. By analogy to plasma beta-2 microglobulin, a close relation of plasma calprotectin to HD vintage was shown.

Topics: Aged; beta 2-Microglobulin; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Enzyme-Linked Immunosorbent Assay; Female; Humans; Interleukin-10; Interleukin-12; Kidney Failure, Chronic; Leukocyte L1 Antigen Complex; Male; Middle Aged; Monocytes; Protein Precursors; Renal Dialysis

Infections trigger the activation of defensive cells capable to produce and release B(2)-microglobulin (B(2)-m). Procalcitonin (PCT), secreted by a wide range of human cells, included the aforementioned defensive cells, is generally considered a sensitive and specific marker of infection. In this prospective study, we examined the possibility that infections, as detected by increased levels of PCT, increase the serum levels of B(2)-m in chronic hemodialysis (CHD) patients, possibly affecting the rate of progression of dialysis-related amyloidosis (DRA).. For a period of four months, 76 CHD patients, 45 men/31 women, mean age 63 +/- 15.7 years, with no residual renal function and in HD for 46 +/- 50 months were studied bimonthly. Blood was drawn, at baseline T(0), two months T(2), and four months T(4), for measuring hematocrit (Ht), white blood cells (WBC), erythrocyte sedimentation rate (ESR), blood urea and serum creatinine, protein (albumin, globulin), C-reactive protein (CRP), and PCT kappa alpha iota B(2)-m. Any events (especially infections) in the preceding 10-day period were recorded.. At baseline, 100% of all B(2)-m measurements were abnormal (>2.4 mg/L), 13.4% of PCT values were increased (>1.5 ng/mL), and 49.4% of CRP values exceeded the lower limit of 5 mg/L with no statistically significant differences between the results of the three periods of the study. Statistically significant, in all periods, was the linear positive correlation of B(2)-m with PCT (T[0]: p < 0.001, T[2]: p < 0.004, T[4]: p < 0.001). Also, statistically significant (p < 0.005) was the positive correlation of B(2)-m to HD vintage.. In this study, the strong positive correlation of B(2)-m to PCT probably signifies that the (mainly subclinical) infections increase B(2)-m production in CHD patients intensifying the problem of HD-related amyloidosis.

Topics: Aged; Amyloidosis; beta 2-Microglobulin; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Glycoproteins; Humans; Infections; Kidney Failure, Chronic; Male; Middle Aged; Prospective Studies; Protein Precursors; Renal Dialysis

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.

Topics: Adolescent; Bacterial Infections; beta 2-Microglobulin; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Child; Child, Preschool; Female; Humans; Kidney Failure, Chronic; Male; Protein Precursors; Renal Dialysis

Serum procalcitonin (PCT), an accurate marker of severe infection, is moderately increased in chronic kidney disease (CKD), peritoneal dialysis (PD) and haemodialysis (HD). We studied the extent of PCT elevation and factors accounting for elevated PCT in CKD and dialysis, and whether peripheral blood mononuclear cells (PBMC) contribute to increased PCT. In 37 controls, 281 CKD, 31 PD, and 65 HD patients without infection, PCT was measured and correlated with CKD stage, PD, HD, C-reactive protein (CRP), cardiovascular disease (CVD) and other clinical parameters. PCT release by PBMC from controls, advanced CKD, PD and HD patients (12 subjects each) was measured. PCT increased in parallel to the deterioration of CKD. Oliguria, advanced CKD, PD, HD, CVD and elevated CRP were independently associated with PCT elevation. PCT release from PBMC significantly increased in advanced CKD, PD and HD. PCT release from PBMC correlated closely with the corresponding serum PCT values (r=0.76, P <0.001). In the absence of infection, PCT may increase due to reduced renal elimination and increased synthesis, as due to PBMC. Furthermore, serum PCT could serve as a marker of low-grade inflammation and CVD, which substantially increase mortality in CKD and dialysis.

Topics: C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cardiovascular Diseases; Cohort Studies; Female; Glomerular Filtration Rate; Humans; Kidney Failure, Chronic; Leukocytes, Mononuclear; Male; Middle Aged; Peritoneal Dialysis; Protein Precursors; Statistics, Nonparametric

The objective of this study was to evaluate the diagnostic value of serum procalcitonin (PCT) in hemodialysis (HD) patients and its correlation to other traditional inflammatory markers.. We measured plasma PCT levels in 120 patients on maintenance HD. PCT levels were compared with C-reactive protein (CRP), interleukin-6 (IL-6), prealbumin, and albumin. We also examined the above parameters subgroups, especially in diabetics and the elderly. Relations between parameters were studied by Spearman's correlation.. PCT concentrations were higher than the upper normal limit of 0.5 ng/ mL in 38% of the patients. All patients with increased CRP had PCT concentrations higher than the upper normal limit. Plasma CRP concentrations were positively correlated to IL-6 (r = 0.304). Prealbumin was negatively correlated with CRP (r = 0.259) and with IL-6 (r = 0.388).. The combination of elevated IL-6 and CRP levels was associated with an altered nutritional status. The concomitant elevations in PCT, CRP, and IL-6 could be more sensitive in the evaluation of inflammation.

Topics: Aged; Analysis of Variance; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cardiovascular Diseases; Cohort Studies; Disease Progression; Female; Follow-Up Studies; Humans; Interleukin-6; Kidney Failure, Chronic; Kidney Function Tests; Male; Middle Aged; Probability; Protein Precursors; Renal Dialysis; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Treatment Outcome

Bacterial infections are associated with a high morbidity and mortality rate in patients with acute and chronic renal failure. Because C-reactive-protein (CRP) is elevated in many patients with renal failure, even in the absence of infection, procalcitonin (PCT) might be useful for the detection of systemic bacterial infections. This cross-sectional observation study measured PCT and CRP in several groups of patients with various types, degrees and treatments of kidney diseases, including patients with sepsis treated with renal replacement therapy.. We determined PCT and CRP in 85 renal patients with different stages and treatments of renal insufficiency: chronic renal failure (CRF) n=23, patients undergoing continuous ambulatory peritoneal dialysis (CAPD) n=20, patients undergoing hemodialysis therapy (HD) n=42 and in a group of 40 patients with septic conditions, including 20 patients with acute renal failure (ARF). The infectious status of the patients was monitored.. PCT in serum (reference value in healthy controls < 1 microg/l) was within the normal range in patients with CRF and in patients on both short-term HD (< 1 year) and long-term HD (> 1 year) (median of 0.25 microg/l and 0.61 microg/l). However, PCT was elevated in patients on CAPD (median of 1.18 microg/l). In patients with sepsis, PCT was massively elevated in both the presence and absence of ARF. In contrast, CRP (reference value < 5 mg/l) was markedly increased in patients undergoing short- and long-term HD (medians of 14.5 and 51.1 mg/l) but not in patients on CAPD. In patients with CRF and systemic bacterial infections, both PCT and CRP were markedly elevated (median PCT 63 microg/l, CRP 130 mg/l) but, in contrast to PCT, CRP values overlapped in infected and non-infected patients. There was no relevant decrease in plasma concentrations of PCT by hemofiltration or hemodialysis in patients with sepsis.. With the exception of CAPD patients, PCT levels were not significantly affected by renal diseases or treatments but were markedly elevated in the presence of infections. Thus PCT is a valuable marker for early diagnosis of systemic bacterial infections in patients with CRF or patients undergoing HD. In contrast, CRP is elevated in several groups with renal diseases and has low specificity for the diagnosis of bacterial infections.

Topics: Acute Kidney Injury; Adult; Aged; Aged, 80 and over; Bacterial Infections; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cross-Sectional Studies; Data Interpretation, Statistical; Diagnosis, Differential; Female; Hemofiltration; Humans; Inflammation; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Protein Precursors; Renal Dialysis; Sensitivity and Specificity; Sepsis; Time Factors

To assess procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations and clearance in nonseptic end-stage renal failure patients undergoing their first three hemodialysis sessions.. Prospective observational consecutive clinical study at a university hospital.. The study recruited 55 end-stage renal failure patients without evidence of systemic infection undergoing the creation of an arteriovenous fistula to start hemodialysis for the first time.. Blood samples were collected before and after each of the first three (4-5 h) hemodialysis sessions. PCT was assayed by immunoluminometry.. The mean plasma concentration of PCT prior to the first three hemodialysis sessions declined significantly following each session. There was no significant difference between CRP plasma concentrations before and after hemodialysis sessions.. The presence of an elevated PCT in plasma of not yet dialyzed uremic nonseptic patients indicates that uremia per se and not the dialysis process is the origin of such elevation. PCT levels declined with successive hemodialysis sessions. We propose that in the not yet dialyzed uremic nonseptic patients a baseline PCT level of approx. 1.5 ng/ml should be expected. Although the mean plasma CRP level was elevated, hemodialysis had no significant effect on CRP concentration, making CRP a possible useful marker of sepsis in these patients.

Topics: Aged; Analysis of Variance; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Prospective Studies; Protein Precursors; Renal Replacement Therapy; Uremia

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.. 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.. 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.. 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.

Topics: Acute Kidney Injury; Adult; Aged; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Infections; Kidney Failure, Chronic; Leukocyte Count; Male; Membranes, Artificial; Middle Aged; Prospective Studies; Protein Precursors; Renal Dialysis; Sensitivity and Specificity

Topics: C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Glycoproteins; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Protein Precursors; Renal Dialysis