Skip to main content

Endocan removal during continuous renal replacement therapy: does it affect the reliability of this biomarker?

A Letter to this article was published on 03 September 2019

The Original Article was published on 26 October 2018

We read the narrative review by De Freitas Caires et al. with great interest [1]. Acute kidney injury (AKI) is prevalent among patients with sepsis, and a substantial proportion of patients with sepsis-associated AKI (SA-AKI) require renal replacement therapy (RRT) [2]. Continuous RRT (CRRT) is increasingly used (~ 20% SA-AKI) among hemodynamically unstable septic shock patients [2]. Endocan as a novel endothelium-derived soluble dermatan sulfate proteoglycan has a molecular mass of around 20 kDa [3]. The contemporary CRRT membranes are able to remove molecules as large as 35 kDa. Hence, endocan could be removed by CRRT [4]. When new highly adsorptive membranes (HAM) with high absorptive abilities are used, the ability of CRRT to eliminate endocan could be even enhanced [4]. Therefore, the reliability of endocan during CRRT could be altered. De Freitas Caires et al. show that endocan appeared as a consistent good diagnostic criterion as well as procalcitonin (PCT) and could potentially be used for de-escalation therapy in the future (requiring new studies obviously) as PCT. Accordingly (if endocan is used for de-escalation in the future), falsely low endocan in CRRT patients, in turn, could lead to an earlier de-escalation of antibiotics and level of care for septic patients. There has been no investigation on the performance of endocan on patients who receive CRRT. Therefore, we believe there is a critical need for a future study with a focus on the performance of the currently known sepsis biomarkers among those who receive CRRT [5].



Acute kidney injury


Continuous renal replacement therapy


Highly adsorptive membranes




Renal replacement therapy


Sepsis-associated AKI


  1. De Freitas Caires N, Gaudet A, Portier L, Tsicopoulos A, Mathieu D, Lassalle P. Endocan, sepsis, pneumonia, and acute respiratory distress syndrome. Crit Care. 2018;22(1):280.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Peters E, Antonelli M, Wittebole X, Nanchal R, François B, Sakr Y, et al. A worldwide multicentre evaluation of the influence of deterioration or improvement of acute kidney injury on clinical outcome in critically ill patients with and without sepsis at ICU admission: results from The Intensive Care Over Nations audit. Crit Care. 2018;22(1):188.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lassalle P, Molet S, Janin A, Heyden JV, Tavernier J, Fiers W, et al. ESM-1 is a novel human endothelial cell-specific molecule expressed in lung and regulated by cytokines. J Biol Chem. 1996;271:20458–64.

    Article  CAS  PubMed  Google Scholar 

  4. Honoré PM, De Bels D, Spapen HD. An update on membranes and cartridges for extracorporeal blood purification in sepsis and septic shock. Curr Opin Crit Care. 2018;24(6):463–8.

    Article  PubMed  Google Scholar 

  5. Honoré PM, Jacobs R, De Waele E, Van Gorp V, Spapen HD. Evaluating sepsis during continuous dialysis: are biomarkers still valid? Blood Purif. 2014;38(2):104–5. Epub 2014 Oct 17.

    Article  PubMed  Google Scholar 

Download references





Availability of data and materials

Not applicable.

Author information

Authors and Affiliations



PMH and KK designed the paper. All authors participated in drafting the manuscript. All authors have read and approved the final version.

Corresponding author

Correspondence to Patrick M. Honore.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Additional information

This comment refers to the article available at

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Honore, P.M., De Bels, D., Attou, R. et al. Endocan removal during continuous renal replacement therapy: does it affect the reliability of this biomarker?. Crit Care 23, 184 (2019).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: