&amp;beta;&lt;sub&gt;2&lt;/sub&gt;-Microglobulin Removal by Hemodialysis with Polymethylmethacrylate Membranes

Adsorption is based on the attraction between the sorbent and the solute through hydrophobic interactions, ionic or electrostatic forces, hydrogen bonding or van der Waals forces. Adsorption is the adherence of molecules by the above-mentioned forces not only to the surface of the membrane but also to its interior. Since polymethylmethacrylate membranes have a much higher inside effective exchange surface than polysulfone membranes, these membranes are able to ensure a high level of adsorption, and therefore reduce the concentration of high-molecular-weight molecules and protein-bound uremic toxins.

Section: Figmentioning

confidence: 98%

Adsorption Techniques: Dialysis Sorbents and Membranes

Perego¹

2013

“…Clinical studies have shown that the PMMA membrane may have a beneficial effect on the treatment and prevention of b2M amyloidosis. Combining the clinical and kinetic studies, it seems that the use of PMMA is clinically desiderable from the viewpoint of prevention of long-term dialysis-related amyloidosis [41]. …”

Section: Clinical Applications Of Adsorption Dialysismentioning

confidence: 99%

Adsorption Dialysis: From Physical Principles to Clinical Applications

Aucella

Gesuete

Vigilante³

et al. 2013

The uremic syndrome is characterized by the retention of various solutes that would normally be excreted by the kidneys. The substances that interact negatively with biologic functions are called uremic toxins. Over the past five decades, the membranes used for the treatment of chronic kidney disease have continuously evolved. The exposure of blood to any extracorporeal artificial surface results in the activation of several pathways within the body, including those involving coagulation and complement activation. One of the by-products of this generalized activation process is protein adsorption to the membrane surface, another phenomenon which can have a significant impact on solute removal. In fact, an array of studies showed that with increasing size of middle-sized proteins and other compounds, relatively more clearance is achieved by membrane adsorption compared with loss into the dialysate. A high adsorptive capacity, one of the main features of polymethylmethacrylate (PMMA) membranes, is very helpful and may both increase the total amount of solutes removed and remove different kinds of solutes. In this setting, a few studies have shown a variety of efficient clinical implications for adsorption hemodialysis, such as uremic pruritus, anemia, carpal tunnel syndrome and renal amyloidosis, immune dysfunction and improved response to vaccination. In addition, nutrition and survival were also improved using PMMA membranes.

“…PMMA adsorption capabilities have been demonstrated in both in vivo and in vitro studies. Campistol et al [19], using radiolabelled β 2 -microglobulin and scintigraphic analysis (on the right), have demonstrated β 2 -microglobulin removal by adsorption. This did not happen using a high-flux PS membrane, which is able to do so only by filtration. …”

Section: Light Chain Removal In the Chronic Haemodialysis Patientmentioning

confidence: 99%

The <under>D</under>oubl<under>e</under> Po<under>l</under>ym<under>e</under>thylmethacryla<under>te</under> Filter (DELETE System) in the Removal of Light Chains in Chronic Dialysis Patients with Multiple Myeloma

Santoro

Grazia

Mancini³

2013

Multiple myeloma (MM) is still one of the most common haematological diseases and is associated with a poor prognosis. It is frequently worsened by acute kidney failure that, in turn, aggravates the risk of death. In the past few years, the idea has made headway that the removal of free light chains (FLC) by means of extracorporeal blood purification systems may facilitate the recovery of renal function. Up to now, many different extracorporeal techniques have been put forward in FLC removal, such as plasma exchange, dialysis with super-flux filters, and adsorption by means of cartridge of resins. In this paper, we illustrate the use of polymethylmethacrylate (PMMA) dialysis membranes with a high adsorptive capacity (Toray BK-F; Toray Industries, Inc., Tokyo, Japan). We have evaluated light chain removal by means of an original dialysis procedure using a double-filter circuit made of PMMA working in sequential dialysis (DELETE system). The system provides satisfactory results in terms of FLC removal and, at the same time, ensures an adequate dialysis treatment (Kt/V >1.5) with significant reduction in urea, creatinine, and β2-microglobulin. The dual PMMA filter system combines an acceptable cost/efficiency ratio when compared with other methods and constitutes a concrete prospect in FLC removal. Its preferential setting of use is in patients with MM or with monoclonal gammopathies, who are on chronic dialysis and maintain high circulating levels of FLC.