Caution in the interpretation of erythrocyte sedimentation rate in haemodialysis and CAPD patients

Agroyannis, B.; Dalamangas, A.; J, Kopelias; Tzanatos, H.; Fourtounas, Konstantinos; Bougatsos, George; Voudiclaris, S; Koutsikos, D.

doi:10.1093/ndt/9.6.734

Cited by 2 publications

(3 citation statements)

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“…Nonetheless, we believe that PCT represents a new and exciting potential marker of inflammation with clinical usefulness, especially in patients with peritonitis. Like PCT, more traditional markers of inflammation, such as CRP, fibrinogen, and ESR, are elevated in some dialysis patients (20-23). Concentration of CRP was elevated in 33.3% of the PD patients in the present study, which is similar to that reported in the literature (21,24).…”

Section: Discussionmentioning

confidence: 99%

Procalcitonin and Conventional Markers of Inflammation in Peritoneal Dialysis Patients and Peritonitis

et al. 2006

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Objectives To determine the significance of a newly described marker of inflammation procalcitonin (PCT), and to investigate its relationship to conventional markers of inflammation, such as C-reactive protein (CRP), fibrinogen, and erythrocyte sedimentation rate (ESR), in patients on peritoneal dialysis (PD) and with peritonitis. Design A prospective, observational clinical study. Setting The Nephrology Division of a University-affiliated teaching hospital. Patients and Methods 51 consecutive patients on PD were included in the study. Of this number, 16 developed peritonitis during the observational period. Baseline PCT, CRP, and fibrinogen concentrations and ESR of 51 PD patients were determined at a time point (TB) prior to any evidence of infection. These results were compared with laboratory values from 74 hemodialysis patients and 34 nonuremic control subjects. All PD patients then were followed prospectively for evidence of peritonitis. In addition to routine blood tests, including hemoglobin and leukocyte count, and routine biochemical tests, blood samples were taken to measure PCT, CRP, and fibrinogen concentrations and ESR at the time (T0) when patients first were diagnosed with PD peritonitis and also on the 4th (T4) and the 14th (T14) days after treatment for peritonitis was initiated. PCT was assayed by immunoluminometry. Results No significant difference was observed between baseline median serum PCT concentrations in PD and hemodialysis patients; however, in both groups, baseline median PCT concentrations were significantly higher than those of nonuremic controls ( p < 0.05). The 16 patients on PD who developed peritonitis had 21 PD peritonitis episodes during the study period. The increased PCT concentration observed at T0 in PD peritonitis episodes decreased with therapy, and this change was statistically significant ( p < 0.05). In a receiver operating characteristic curve analysis for peritonitis, the area under the curve (AUC) for PCT was 0.80, which was significantly lower than the AUC for CRP and greater than the AUCs for fibrinogen and ESR. The sensitivity of PCT for peritonitis was lower than the sensitivity of conventional markers of inflammation; however, the specificity of PCT was higher. Conclusions Median serum PCT concentration in PD patients was significantly higher than in nonuremic controls but not hemodialysis patients. Serum PCT concentrations may serve as a useful adjunct to traditional markers of inflammation in detecting and monitoring inflammation and peritonitis in PD patients.

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Section: Discussionmentioning

confidence: 99%

Procalcitonin and Conventional Markers of Inflammation in Peritoneal Dialysis Patients and Peritonitis

et al. 2006

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“…Since then, there have been only a few reports on the ESR in this population [3, 4, 5, 6]. All of them, except one [5], found that the Westergren ESR of 40 to 70 mm/h was markedly accelerated in HD patients compared with a top normal value of 25 mm/h [7].…”

Section: Introductionmentioning

confidence: 99%

“…All of them, except one [5], found that the Westergren ESR of 40 to 70 mm/h was markedly accelerated in HD patients compared with a top normal value of 25 mm/h [7]. However, none of these studies [1, 2, 3, 4, 5, 6]considered the fact that anemia, which accompanies renal failure, is one of the main factors responsible for accelerated ESR [8]. …”

Section: Introductionmentioning

confidence: 99%

The Hematocrit-Corrected Erythrocyte Sedimentation Rate Can Be Useful in Diagnosing Inflammation in Hemodialysis Patients

Borawski

Myśliwiec

2001

Nephron

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Background/Aims: We aimed to determine predictors of erythrocyte sedimentation rate (ESR), and the ESR level pointing to the presence of inflammation in 60 chronic hemodialysis (HD) patients. Methods/Results: On bivariate analysis, increased Westergren ESR of 62 (4–160) mm/h correlated inversely with hematocrit (Hct) and serum albumin, and positively with age, plasma fibrinogen, serum C-reactive protein (CRP), immunoglobulins A and G, α₁-acid-glycoprotein and α₁-antitrypsin. On multivariable analysis, independent predictors of the ESR were raised CRP (p < 0.0001), low Hct (p < 0.0001), increased fibrinogen (p < 0.0001) and immunoglobulin A (p = 0.009), and older age (p = 0.015). The Hct-corrected ESR level [ESR × (Hct/45)] of 38 (4–91) mm/h was independently predicted by CRP (p < 0.0001), fibrinogen (p < 0.0001), and age (p = 0.001). In the patients with normal CRP and albumin, the Hct-corrected ESR value was normal (23 mm/h) and lower than that of 59 mm/h in the subjects with elevated CRP and hypoalbuminemia. Using these cut-off points, the positive and negative predictive values of the Hct-corrected ESR on the presence of inflammation were 1.0, and its sensitivity and specificity were 100%. Conclusion: Increased Westergren ESR in HD patients is associated with activated acute-phase response, anemia, and aging. The Hct-corrected ESR values of 23 and 59 mm/h precisely select the HD patients with severe inflammation from those without.

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Caution in the interpretation of erythrocyte sedimentation rate in haemodialysis and CAPD patients

Cited by 2 publications

References 0 publications

Procalcitonin and Conventional Markers of Inflammation in Peritoneal Dialysis Patients and Peritonitis

Procalcitonin and Conventional Markers of Inflammation in Peritoneal Dialysis Patients and Peritonitis

The Hematocrit-Corrected Erythrocyte Sedimentation Rate Can Be Useful in Diagnosing Inflammation in Hemodialysis Patients

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