Plasma concentrations and clearance of procalcitonin during continuous veno-venous hemofiltration in septic patients

We determined the elimination characteristics of procalcitonin (PCT) during continuous veno-venous hemofiltration (CVVHF) and the resulting effect on PCT plasma levels. A prospective study was conducted in patients with sepsi s and acute oliguric renal failure, treated with CVVHF using a polysulfone membrane (Baxter Renaflo II PSHF 1200). Patients had sepsis and PCT plasma levels > 4 ng ml(-1) (n = 26). PCT was measured in the pre- and post-filter plasma and the ultrafiltrate at 0, 5, 10, and 15 min and 1, 2, 4, 8, 12, a nd 24 h after setup of CVVHF. PCT sieving coefficient was 0.24. Elimination of PCT, however, depended on the duration of filtration, because filter ad sorption was the main mechanism of PCT clearance during the first hour of h emofiltration, finally increasing to a clearance of PCT into the ultrafiltr ate of 2.8-5.5 mL/min after 2 h. PCT plasma levels were not significantly a ltered during CVVHF (96% of the initial concentration after 24 h, P = 0.72) . Similar to what has been observed with cytokines and other proteins of a comparable molecular weight, PCT is removed from the plasma during CVVHF, b ut plasma PCT levels are unchanged. Thus, PCT can be used as a diagnostic p arameter even in patients with acute renal failure undergoing CVVHF.