Elimination of procalcitonin and plasma concentrations during continuous veno-venous haemodiafiltration in septic patients

The elimination of procalcitonin and the course of plasma concentrations du ring continuous venovenous haemodiafiltration were measured in patients wit h 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 pla sma 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 p atients 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 determin e whether filtration itself induced a procalcitonin response. No interventi ons were required. In patients with low procalcitonin concentrations (proca lcitonin < 2 ng mL(-1)) continuous veno-venous haemodiafiltration did not c ause a rise in procalcitonin. In patients with increased procalcitonin plas ma concentrations (> 3 ng mL(-1)), the protein was removed through the poly sulphone 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 c ontinuous veno-venous haemodiafiltration). Thus, on the average, approximat ely 10% of plasma concentrations were measurable in the filtrate ultimately . However, procalcitonin plasma levels were not significantly altered durin g continuous veno-venous haemodiafiltration (86% of the initial concentrati on after 24 h). Although procalcitonin is removed from the plasma during co ntinuous veno-venous haemodiafiltration in measurable amounts plasma procal citonin concentrations did not change significantly during haemodiafiltrati on. Procalcitonin thus can also be used as a diagnostic parameter in patien ts undergoing continuous veno-venous haemodiafiltration.