Serum procalcitonin concentration in patients on chronic hemodialysis with inflammation of native arterio-venous fistula

Abstract

Infection is one of the leading causes of vascular access failure in patients treated with hemodialysis (HD) (1). At the beginning of this process the symptoms may be unspecific and similar to other non-infectious processes (stenosis, thrombosis, hematoma). Likewise C-reactive protein (CRP) is the most current and frequently used marker of infection and when combined with white blood cell (WBC) count is useful in diagnosis and therapeutic strategy improvement. But these parameters may be affected by uremia, silent underlying disease or by HD per se (2). The concentrations of these parameters may be useful indicators for inflammation in patients with renal disease, but have low specificity for the diagnosis of bacterial infection. Procalcitonin (PCT), 116 amino-acids prohormon of calcitonin is a new marker of acute bacterial or fungal infection, physiologically synthesized by the thyroid C cells (2). PCT levels are not significantly affected by the loss of renal function. The usefulness of PCT as a diagnostic parameter of infection and sepsis was demonstrated in various clinical studies (3-8). PCT is as well routinely measured to differentiate autoimmune disorders from infection. But in the opinion of Dahaba et al. (9) higher plasma of PCT of not dialyzed, uremic and nonseptic patients (pts) indicates that uremia per se and not the dialysis process is the origin of this rise. The early diagnosis of native arteriovenous fistula (AVF) infection is crucial for an appropriate course of the HD treatment. In the