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- Title
Beta2-microglobulin removal and plasma albumin levels with high cut-off hemodialysis.
- Authors
Haase, M; Bellomo, R; Baldwin, I; Haase-Fielitz, A; Fealy, N; Morgera, S; Goehl, H; Storr, M; Boyce, N; Neumayer, H-H
- Abstract
<bold>Purpose: </bold>beta2-microglobulin (beta2MG) is pivotal to the pathogenesis of dialysis-related amyloidosis. We compared the effects of high cut-off hemodialysis (HCO-HD) with those of standard high-flux hemodialysis (HF-HD) regarding the concentration and clearance of beta2MG and albumin.<bold>Design: </bold>We enrolled ten patients with acute renal failure in a double-blind, cross-over, randomized controlled trial.<bold>Procedures: </bold>Each patient received four hours of HCO-HD (estimated in vivo cutoff 50-60 kDa) and four hours of HF-HD (estimated in vivo cutoff 15-20 kDa) in random order. Statistical methods and outcome measures: As data lacked normal distribution, we used nonparametric statistical analysis. Plasma and dialysate concentrations of beta2MG and albumin were measured at baseline and after four hours of each study treatment.<bold>Main Findings: </bold>We found significantly greater diffusive beta2MG clearances for HCO-HD compared to HF-HD (at the start: 71.8 ml/min vs. 5.1 ml/min; P=0.008 and at the end: 68.8 ml/min vs. 5.7 ml/min; P=0.008). We found a reduction in plasma beta2MG concentrations of -31.6% during HCO-HD compared to an increase by 25.7% during HF-HD; P=0.008. At baseline (HCO-HD: 26.0 g/L vs. HF-HD: 26.5 g/L), and at the end of both treatments, plasma albumin concentrations were comparable (HCO-HD: 25.5 g/L vs. HF-HD: 26.5 g/L; P=0.25). During HCO-HD, albumin clearance was 1.9 ml/min at the start and decreased significantly to 0.8 ml/min at the end; P=0.008. HF-HD had an albumin clearance of 0.01 ml/min.<bold>Conclusions: </bold>HCO-HD was more effective in decreasing plasma beta2MG concentrations than standard HF-HD and did not reduce plasma albumin levels. Further studies of HCO-HD in the treatment of dialysis-related beta2MG accumulation appear warranted.
- Publication
International Journal of Artificial Organs, 2007, Vol 30, Issue 5, p385
- ISSN
0391-3988
- Publication type
journal article
- DOI
10.1177/039139880703000505