Serum Procalcitonin Levels in Patients With End-Stage Renal Disease (Esrd)

Abstract

Background: Although procalcitonin (PCT) has been described as a new marker of inflammation in dialysis patients, it has not been studied in patients with end-stage renal disease (ERSD) in Viet Nam. The objective of this study was to evaluate: serum PCT levels in patients with ERSD and its association to other inflammation (hs-CRP, IL-6) and nutritional (albumin, prealbumin, BMI) factors and the cardiovascular disease (CVD) events (heart failure, cerebrovascular disease, coronary heart disease, urgence hypertension) after 1-year follow-up. Subjects and methods: A total of 174 patients without infection (include: 57 predialysis patients, 56 continuous ambulatory peritoneal dialysis patients, 61 hemodialysis patients) were enrolled. Inflammatory markers (PCT, hs-CRP, IL-6) and nutritional parameters (albumin, prealbumin, BMI) were determined. CVD events (heart failure, cerebrovascular disease, coronary heart disease, urgence hypertension) were evaluated during 12 months of follow-up. Results: The median baseline serum PCT levels of them were 0.44 ng/ml (0.23 – 0.98). Of them, 79 patients (45.4%) had baseline serum PCT levels of over 0.5 ng/ml, which is the cut-off point suggestive of sepsis in non-dialytic individuals. Hemodialysis patients was associated with significantly higher PCT values than predialysis and peritoneal dialysis patients. The patients with elevated PCT plasma levels had the BMI lower. PCT and IL-6 were positively correlated with each other. Compared to patients with serum PCT levels of under 0.5 ng/ml, patients with serum PCT levels of over 0.5 ng/ml had an increased CVD risk in 12 months of follow-up (HR: 2.09; 95% CI: 1.31-3.33; p=0.002). Conclusion: In the absence of infection, PCT may increase due to reduced renal elimination and increased synthesis. Furthermore, serum PCT could serve as a marker of low-grade inflammation, which substantially increase CVD events risk in patients with ERSD. Keywords: Procalcitonin, end-stage renal disease