Assessment of the influence of expanded hemodialysis on the rate of removal of middle molecular weight uremic toxins

Abstract

Objective. The aim of this study was to examine the effect of expanded hemodialysis on the degree of b2-microglobulin removal. Methods. Sixteen patients treated with extended MCO hemodialysis were examined. The main parameter for assessing the efficiency of removal of uremic toxins of middle molecular weight is the concentration of b2-microglobulin in the serum before and after a single session of extended MCO hemodialysis. The following were used for statistical analysis: Kolmogorov-Smirnov test, Student's T test for bound samples and Wilcoxon test. Results. Extended MCO hemodialysis effectively removes uremic toxins of middle molecular weight. The reduction index of b2-microglobulin during a single session of extended MCO hemodialysis is 70.60 ± 5.88%. The average loss of albumin during a single session of extended MCO hemodialysis is 1.88 ± 1.02 g/4h, and the index of albumin reduction is 4.94 ± 2.49%. Conclusion. Extended MCO hemodialysis effectively removes b2-microglobulin. The b2-microglobulin reduction index is ~ 71% and the albumin loss is less than 4.0 g/4h. This dialysis modality prevents the development of amyloidosis, atherosclerosis and atherosclerotic cardiovascular diseases in the population of patients treated with regular hemodialysis.

Assessment of the Influence of Asymmetric Triacetate Cellulose Membrane on the Rate of Removal of Middle Molecular Weight Uremic Toxins in Patients Treated with Postdilution Online Hemodiafiltration

“…To prevent the development of complications of long-term hemodialysis treatment, post-dilution OL-HDF should enable RR-β2M of 80% (RR-β2M ≥ 80%) and RR-α1M of 35% (RR-α1M ≥ 35%) [35]. The results of the research done so far have shown that during a single session of high-flux "high-flux" hemodialysis RR-β2M is 50-60%, in extended hemodialysis ("medium cut-off" dialysis membrane) 70%, and in high-volume Vconv ≥ 22 liters/session) post-dilution OL-HDF 80-85% (RR-β2M ≥ 80%) [36], [37], [38]. In patients treated with postdilution OL-HDF with asymmetric triacetate cellulose dialysis membrane, at a blood flow rate of Qb = 400 mL/min, volume substitution -Vsubs = 24 liters/session and total convective volume -Vconv = 27.4 ± 3.4, RR-β2M was 79.3 ± 4.7%, and albumin loss during a single postdilution OL-HDF session about 500 mg (384.8-596.7 mg/4 h) [39].…”

Comparison of efficiency of medium molecular weight uremic toxin removal between high-flux hemodialysis and postdilution online hemodiafiltration

“…Ovi uremijski toksini se efikasno uklanjaju konvencionalnom visokopropusnom hemodijalizom (0,5-20 kDa), postdilucionom online hemodijafiltracijom (0,5-60 kDa) i proširenom hemodijalizom -ED (0,5-60 kDa) (engl. Expanded Dialysis) (3,4). U uremijske toksine srednje molekulske mase spadaju proteini (β2-mikroglobulin), prozapaljenski citokini (interleukin-1β, interleukin-6, interleukin-18, faktor nekroze tumora alfa -TNF), proteini zapaljenja (pentraxin-3, YKL-40) i adipokini (leptin) (4).…”