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Observational Study
. 2021 Aug;36(8):2405-2409.
doi: 10.1007/s00467-021-04966-4. Epub 2021 Mar 17.

Procalcitonin serum levels in stage 5 chronic kidney disease children on hemodialysis

Antoine Mouche  1 , Cyrielle Parmentier  1   2 , Claire Herbez Rea  1   2 , Thérèsa Kwon  3 , Olivia Boyer  4 , Jean Daniel Delbet  1 , Tim Ulinski  5   6
Affiliations
Observational Study

Procalcitonin serum levels in stage 5 chronic kidney disease children on hemodialysis

Antoine Mouche et al. Pediatr Nephrol. 2021 Aug.

Abstract

Background: Infections are responsible for morbidity and mortality in children on hemodialysis (HD). Procalcitonin (PCT) is rarely used in this population, even though it is an efficient biomarker of infection and sepsis. Our aim was to study PCT baseline level in uninfected children with stage 5 chronic kidney disease (CKD 5) on HD, and determine how to use it in this population.

Methods: Prospective observational study including 40 uninfected children on classical HD or hemodiafiltration (HDF) in three pediatric HD centers in the Paris region. PCT was monitored before and after three consecutive sessions within 1 week.

Results: Median pre-dialysis PCT was 0.60 ng/mL [0.36-1.15], median post-dialysis PCT was 0.23 ng/mL [0.10-0.47], PCT reduction rate was 59.8% [37.5-75.8]. Seventy percent of pre-dialysis PCT were <1 ng/mL. Anuric patients had higher pre-dialysis PCT than those with residual urine output (0.70 [0.42-1.30] vs. 0.48 [0.30-0.93] ng/mL, p=0.01). HDF was more efficient than HD to clear PCT during sessions (reduction rate 75% [67-80] vs. 37 [31-50]), p<0.001).

Conclusion: PCT levels in pediatric HD patients without infection are higher than normal, but this increase is relatively moderate compared to massive increases of PCT in children with bacterial infections on HD. If PCT is measured after dialysis sessions, the specific technique-dependent reduction rates should be taken into consideration. Moderately increased PCT levels around 2 ng/ml should be interpreted with caution; however, higher PCT serum levels can be used to motivate rapid start of antibiotic treatment in pediatric HD patients.

Keywords: Biomarker; Children; Hemodiafiltration; Hemodialysis; Procalcitonin.

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