Kidney Week

Abstract: FR-PO409

Association of Serum Procalcitonin with All-Cause and Cardiovascular Mortality in Patients with ESKD

Session Information

• Hemodialysis Epidemiology and Outcomes
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Sinojia, Kishan, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Kishan Sinojia

• Mallisetty, Yamini, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Yamini Mallisetty, MSc, MPH

• Han, Zhongji, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Zhongji Han, PhD

• Chiu, Chi-Yang, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Chi-Yang Chiu

• Seegmiller, Jesse C., University of Minnesota, Minneapolis, Minnesota, United States

Jesse C. Seegmiller, PhD

• Karger, Amy B., University of Minnesota, Minneapolis, Minnesota, United States

Amy B. Karger, MD, PhD

• Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy, MD, FASN

• Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Keiichi Sumida, MD, PhD, MPH, FASN

Background

Serum procalcitonin (sPCT) is a diagnostic marker of active bacterial infection. Other conditions may also induce sPCT such as proinflammatory cytokines and non-infectious inflammatory conditions. Elevated sPCT has been associated with poor clinical outcomes like cardiovascular disease (CVD) in various patient populations and even in healthy individuals. However, little is known about sPCT associations with all-cause and CV mortality in patients with end-stage kidney disease (ESKD).

Methods

In a nationwide prospective cohort of 941 patients receiving maintenance hemodialysis from 2011-2013, we examined the association of baseline sPCT with all-cause and CV mortality, using the Kaplan-Meier method and Cox proportional hazards models with adjustment for age, sex, dialysis vintage, vascular access type, BMI, systolic blood pressure, Charlson Comorbidity Index, ischemic heart disease, diabetes mellitus, serum albumin, hemoglobin, white blood cell count, infectious hospitalization, culture-positive bacteremia, and antibiotic or antifungal use. Since a sPCT does not have a universal cut-off interval accepted in dialysis patients, sPCT was treated as a median-stratified binary variable (≥ vs. <0.51 ng/mL).

Results

Overall, patients were 60±13 years old; 53% were male; 40% were African American; and 57% were diabetic. The mean dialysis vintage was 4.3±3.8 years. No patient had clinical evidence of infection at baseline. During a median follow-up of 2.2 years, 204 and 74 patients experienced all-cause and CV death, respectively. The all-cause and CV death rates were higher in those with higher sPCT (log-rank P = 0.033 and 0.13, respectively; Figure). The adjusted hazard ratios [95% CI] of all-cause and CV mortality associated with higher sPCT were 1.48 [1.11-1.98] and 1.67 [1.03-2.69], respectively.

Conclusion

Higher sPCT was significantly associated with higher risk of all-cause and CV mortality in patients with ESKD. sPCT may be a useful biomarker for the risk of premature death even in those without overt infection.

Funding

• NIDDK Support