Beta-2-Microglobulin Generation Rate and Clearance Rate in Maintenance Hemodialysis Patients

Abstract

We analyzed the rebound pattern of plasma β₂-microglobulin (β₂-m) concentration from 4 h after completion of hemodiafiltration until the start of the next treatment according to the one-pool β₂-m kinetic model so as to determine β₂-m generation rate and whole-body β₂-m clearance. Next, we obtained the whole renal β₂-m clearance as the product of renal creatinine clearance and the glomerular sieving coefficient of β₂-m. Then, extrarenal β₂-m clearance was calculated as the difference between whole-body β₂-m clearance and whole renal β₂-m clearance, and renal β₂-m clearance due to tubular absorption was taken to be the difference between whole renal β₂-m clearance and renal β₂-m clearance due to urinary excretion. The results showed that the β₂-m generation rate was virtually the same for all patients and that the higher the patients and that the higher the patients’ plasma β₂-m concentration was, the lower was the whole-body β₂-m clearance. Moreover, in the present study, an inverse correlation was found between the following respective factors: plasma β₂-m concentration and whole renal β₂-m clearance; plasma concentration and renal clearance due to tubular absorption; plasma concentration and renal clearance due to urinary excretion. However, there was no correlation between plasma β₂-m concentration and extrarenal β₂-m clearance. The findings indicate that the variation of plasma β₂-m concentration with the individual patient is solely attributable to the variation in residual renal function in terms of β₂-m elimination.

Comparison of residual renal function in patients undergoing twice‐weekly versus three‐times‐weekly haemodialysis

“…22,23 HD patients with RRF are also known to have lower levels of b2-microglobulin, better nutritional status and better quality of life. [24][25][26][27] Consistent with these studies, compared with our thrice-weekly HD group, our twice-weekly HD group had a significantly lower level of serum b2-microglobulin at the end of the follow-up period. We believe this may be attributable to the higher RRF in the twice-weekly group.…”

Long-Term On-Line Hemodiafiltration Reduces Predialysis Beta-2-Microglobulin Levels in Chronic Hemodialysis Patients

“…The serum concentration of ß 2 -microglobulin is accounted for by its generation rate, duration of dialysis treatment, and whole body clearance (renal plus extrarenal clearance) [20]. In our study, these results suggest that the improved clearance of ß 2 -microglobulin could not completely account for the lower predialysis ß 2 -microglobulin observed in HDF-treated patients.…”

“…The use of a highly biocompatible membrane-like polysulfone, and an ultrapure/sterile dialysate, have been reported to be associated with lower ß 2 -microglobulin serum concentrations [21], a reduced incidence of carpal tunnel syndrome [22], and a decreased degree of inflammatory cytokine induction [23]. Maeda et al [20] reported that ß 2 -microglobulin generation is not stimulated by the polysulfone membrane during HDF. Thus, the combination of a significant removal of ß 2 -microglobulin and other middle to large molecular uremic toxins, with a lower inflammatory stimulation through using a biocompatible membrane and a sterile fluid system, may all play a role in the observed lower predialysis ß 2 -microglobulin level in our HDF patients.…”

Relative Importance of Residual Renal Function and Convection in Determining Beta-2-Microglobulin Levels in High-Flux Haemodialysis and On-Line Haemodiafiltration

“…In HDF there is even less data. Maeda et al [22] studied the rebound in plasma ␤ 2 M levels following HDF and concluded that their variation within individual patients was solely attributable to the variation in residual renal function. The half-life of 131 I-␤ 2 M was less in haemofiltered than in haemodialysed patients, but similar to that in patients with residual renal function [23] .…”