Juergen Prattes1, Daniel Schneditz2, Florian Prüller3, Eva Jaindl4, Notburga Sauseng5, Martin Hoenigl6, Gernot Schilcher7, Robert Krause8. 1. Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; CBmed GmbH - Center for Biomarker Research in Medicine, Stiftingtalstrasse 5, 8010 Graz, Austria. 2. Institute of Physiology, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria. Electronic address: daniel.schneditz@medunigraz.at. 3. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria. 4. Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria. 5. Institute of Physiology, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria. 6. Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; CBmed GmbH - Center for Biomarker Research in Medicine, Stiftingtalstrasse 5, 8010 Graz, Austria; Division of Infectious Diseases, Department of Medicine, University of California, 9500 Gilman Drive, 0711 La Jolla, CA, USA. 7. Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria. 8. Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria; CBmed GmbH - Center for Biomarker Research in Medicine, Stiftingtalstrasse 5, 8010 Graz, Austria. Electronic address: robert.krause@medunigraz.at.
Abstract
BACKGROUND: The aim of this combined in-vitro and in-vivo study was to investigate whether state of the art dialysis modalities produce false positive serum 1,3-ß-d-Glucan (BDG) levels. METHODS: Dialysis fluid for simulated dialysis treatments was spiked with BDG from different sources. Samples were taken from the dialysate and dialyzer blood compartments at various time points. In addition, serum samples were obtained in three groups of patients without invasive fungal disease: a.) twelve patients on chronic hemodialysis (HD)/hemodiafiltration (HDF); b.) ten patients on continuous ambulatory peritoneal dialysis (CAPD); and c.) ten patients with stable chronic kidney disease (CKD) but without dialysis. RESULTS: Median BDG levels in BDG spiked dialysate were 3250.9, 2050.4, and 390.1 pg/ml respectively. All corresponding samples from the blood compartments were BDG negative. In HD/HDF patients no increase of serum BDG levels could be observed over the duration of treatment. 71/72 BDG tests in this group remained negative. BDG tests were also negative in 9/10 CAPD patients, both in in- and outflow dialysates as well as in all ten patients with CKD. CONCLUSION: We conclude that state of the art renal replacement therapies using up-to-date treatments are not a cause of falsely elevated serum BDG levels.
BACKGROUND: The aim of this combined in-vitro and in-vivo study was to investigate whether state of the art dialysis modalities produce false positive serum 1,3-ß-d-Glucan (BDG) levels. METHODS: Dialysis fluid for simulated dialysis treatments was spiked with BDG from different sources. Samples were taken from the dialysate and dialyzer blood compartments at various time points. In addition, serum samples were obtained in three groups of patients without invasive fungal disease: a.) twelve patients on chronic hemodialysis (HD)/hemodiafiltration (HDF); b.) ten patients on continuous ambulatory peritoneal dialysis (CAPD); and c.) ten patients with stable chronic kidney disease (CKD) but without dialysis. RESULTS: Median BDG levels in BDG spiked dialysate were 3250.9, 2050.4, and 390.1 pg/ml respectively. All corresponding samples from the blood compartments were BDG negative. In HD/HDF patients no increase of serum BDG levels could be observed over the duration of treatment. 71/72 BDG tests in this group remained negative. BDG tests were also negative in 9/10 CAPD patients, both in in- and outflow dialysates as well as in all ten patients with CKD. CONCLUSION: We conclude that state of the art renal replacement therapies using up-to-date treatments are not a cause of falsely elevated serum BDG levels.
Authors: Alexander Szyszkowitz; Christoph Zurl; Anna Herzeg; Anton Berger; Geza Gemes; Martin Mitteregger; Florian Prüller; Juergen Prattes; Ines Zollner-Schwetz; Thomas Valentin; Martin Hoenigl; Robert Krause Journal: Open Forum Infect Dis Date: 2018-11-08 Impact factor: 3.835