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Changes of Early Sepsis Biomarker Presepsin Level during Hemodialysis: Influence of β 2 -Microglobulin Clearance of Dialysis Membrane: A Preliminary Study.

Kidney Diseases 2019 Februrary
Background: Although presepsin (P-SEP) is an early sepsis biomarker, sepsis is often suspected after starting hemodialysis (HD). To enhance the utility of P-SEP, we investigated whether pre-HD P-SEP levels could be predicted using the P-SEP levels from blood samples collected after starting HD.

Methods: We observed P-SEP level changes due to HD and dialyzer passage in HD patients using a dialysis membrane with a β2 -microglobulin (β2 -MG) clearance of either ≥50 mL/min (high-flux) or < 30 mL/min (intermediate-flux). We calculated the removal ratios for the elimination of P-SEP or the predicted pre-HD P-SEP levels based on the correction of hemoconcentration.

Results: The P-SEP levels significantly decreased at 4 h after starting HD ( n = 8) using membranes with a β2 -MG clearance ≥50 mL/min; the removal ratios at 2 and 4 h were 42.8 ± 7.9% and 58.8 ± 18.4%, respectively. In contrast, the P-SEP levels did not decrease during the passage of dialyzer in 2 patients with a β2 -MG clearance < 30 mL/min, and the P-SEP levels increased during HD in all patients ( n = 10, including the abovementioned 2 patients) with a β2 -MG clearance < 30 mL/min. The predicted pre-HD P-SEP levels ( y ) were strongly correlated with the actually measured pre-HD P-SEP levels ( x ) ( R 2 = 0.9562) using the regression equation: y = 1.0987 x .

Conclusion: The levels of P-SEP with a molecular weight near that of β2 -MG decreased similarly to those of β2 -MG during HD using membranes with a β2 -MG clearance ≥50 mL/min. On the contrary, the levels of P-SEP rather increased during HD with a β2 -MG clearance < 30 mL/min, suggesting that P-SEP appeared not to be eliminated. Furthermore, the pre-HD P-SEP levels might be predictable by the correction of hemoconcentration using even blood samples collected after starting HD with a β2 -MG clearance < 30 mL/min.

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