Convective and adsorptive removal of β2-microglobulin during predilutional and postdilutional hemofiltration

Padrini, Roberto; Canova, Cristina; Conz, P; Mancini, Elena; Rizzioli, Emanuela; Santoro, Antonio

doi:10.1111/j.1523-1755.2005.00694.x

Cited by 27 publications

(26 citation statements)

References 20 publications

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“…The finding that HDF was very effective in reducing elevated levels of ␤ 2 -microglobulin by almost 69%, is in line with recent data on postdilution HDF [10] . Although HDF was strikingly superior in eliminating ␤ 2 -microglobulin, we did not see a significant difference in the reduction of plasma ADMA levels by HD (35%) or HDF (40%).…”

Section: Discussionsupporting

confidence: 80%

No Benefit of Hemodiafiltration over Hemodialysis in Lowering Elevated Levels of Asymmetric Dimethylarginine in ESRD Patients

Kalousová¹,

Kielstein

Hodková

et al. 2006

Blood Purif

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Background: It has been suggested that hemodiafiltration (HDF) is more efficient than hemodialysis (HD) in lowering plasma levels of the endogenous nitric oxide synthase inhibitor asymmetric dimethylarginine (ADMA), which is a strong and independent predictor of overall mortality in ESRD patients. Methods/Patients: Twenty ESRD patients (11 women) were studied during both a single online HDF session and a single HD session. In each patient, ADMA, L-arginine, SDMA, β₂-microglobulin and urea were measured at several time points. Results: Although HDF was clearly superior to HD in decreasing plasma β₂-microglobulin, there was no difference in the elimination characteristics of ADMA. However, HDF but not HD eliminated the nitric oxide synthase substrate L-arginine, making HD superior in increasing the L-arginine/ADMA ratio. Conclusion: Neither HD nor HDF sufficiently removes the putative uremic toxin ADMA. The clinical significance of HD better improving the L-arginine/ADMA ratio (parameter of NO production) as compared to HDF needs to be determined.

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Section: Discussionsupporting

confidence: 80%

No Benefit of Hemodiafiltration over Hemodialysis in Lowering Elevated Levels of Asymmetric Dimethylarginine in ESRD Patients

Kalousová¹,

Kielstein

Hodková

et al. 2006

Blood Purif

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“…Patients treated with cellulose membranes were shown to have higher ␤2M levels (22). Adsorption to the dialyzer membrane partly contributes to ␤2M removal (26) and may also differ between various types of dialyzers (27). In addition, the use of ultrapure dialysis fluid has been associated with lower ␤2M concentrations, possibly because of a decreased inflammatory response and subsequent decreased ␤2M production (28)(29)(30).…”

Section: Discussionmentioning

confidence: 99%

Role of Residual Kidney Function and Convective Volume on Change in β2-Microglobulin Levels in Hemodiafiltration Patients

Penne

Weerd

Blankestijn

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Removal of ␤ 2 -microglobulin (␤2M) can be increased by adding convective transport to hemodialysis (HD). The aim of this study was to investigate the change in ␤2M levels after 6-mo treatment with hemodiafiltration (HDF) and to evaluate the role of residual kidney function (RKF) and the amount of convective volume with this change.Design, setting, participants, & measurements: Predialysis serum ␤2M levels were evaluated in 230 patients with and 176 patients without RKF from the CONvective TRAnsport STudy (CONTRAST) at baseline and 6 mo after randomization for online HDF or low-flux HD. In HDF patients, potential determinants of change in ␤2M were analyzed using multivariable linear regression models.Results: Mean serum ␤2M levels decreased from 29.5 ؎ 0.8 (؎SEM) at baseline to 24.3 ؎ 0.6 mg/L after 6 mo in HDF patients and increased from 31.9 ؎ 0.9 to 34.4 ؎ 1.0 mg/L in HD patients, with the difference of change between treatment groups being statistically significant (regression coefficient ؊7.7 mg/L, 95% confidence interval ؊9.5 to ؊5.6, P < 0.001). This difference was more pronounced in patients without RKF as compared with patients with RKF. In HDF patients, ␤2M levels remained unchanged in patients with GFR >4.2 ml/min/1.73 m 2 . The ␤2M decrease was not related to convective volume. Conclusions: This study demonstrated effective lowering of ␤2M levels by HDF, especially in patients without RKF. The role of the amount of convective volume on ␤2M decrease appears limited, possibly because of resistance to ␤2M transfer between body compartments.

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“…The value of plasma ␤ 2 M clearance in the simple mid-dilution OL-HDF was higher than in prior work despite the lower baseline serum ␤ 2 M levels ( table 3 ). Furthermore, ␤ 2 M clearance in the present study was assessed as plasma water ␤ 2 M clearance and was determined by AUC calculation [17] , both of which were more accurate than the conventional measurements utilized in all earlier studies. As illustrated in table 3 , the magnitude of albumin loss in the simple mid-dilution OL-HDF was lower than the original method in previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…The mean dialytic ␤ 2 M plasma water clearances for total (CLpw tot ), convective plus diffusion (CLpw convective + diffusion ), and membrane adsorption (CLpw ads ) were calculated using the amount of ␤ 2 M removed from plasma during the 4-hour period for total (A tot ), convection plus diffusion (A convection + diffusion ), and adsorption (A ads ), respectively [17] : Cpw in was obtained from Cp in and total plasma protein concentration (Pt, g/dl) using Colton's formula [18] :…”

Section: Small Molecule Clearancementioning

confidence: 99%

A Simple Efficient Technique of ‘Mid-Dilution’ On-Line Hemodiafiltration

Susantitaphong

Tiranathanagul²,

Hanvivatvong³

et al. 2009

Blood Purif

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Background: On-line hemodiafiltration (OL-HDF) with pre- as well as post-dilution reinfusion mode provides superior uremic toxin removal, especially middle uremic toxins, and can improve patient survival. Both standard pre- and post-dilution have limitations. Mid-dilution OL-HDF (Nephros OLpur™) was invented to overcome the disadvantages of both standard modes, but such a cartridge is only available in limited centers and is expensive. Methods: We created a simple technique of mid-dilution OL-HDF that can be easily set up in every hemodialysis center. Twelve stable end-stage renal disease patients were dialyzed in a random sequence with three different infusion modes of OL-HDF (simple mid-dilution, standard pre-dilution and post-dilution). Small molecule, middle molecule, and protein-bound uremic toxin clearances were measured. Results: Simple mid-dilution OL-HDF provided high efficiency in uremic toxin clearances with less protein loss. Conclusion: Simple mid-dilution OL-HDF combines the advantages of pre- and post-dilution modes without adverse effects. Thus, this technique could be useful in decreasing morbidity and mortality in hemodialysis patients.

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Convective and adsorptive removal of β2-microglobulin during predilutional and postdilutional hemofiltration

Abstract: The 2 techniques appear to be equivalent in terms of total beta2-m removal, although this final result is obtained by different contributions of convective and adsorptive elimination.

Cited by 27 publications

References 20 publications

No Benefit of Hemodiafiltration over Hemodialysis in Lowering Elevated Levels of Asymmetric Dimethylarginine in ESRD Patients

No Benefit of Hemodiafiltration over Hemodialysis in Lowering Elevated Levels of Asymmetric Dimethylarginine in ESRD Patients

Role of Residual Kidney Function and Convective Volume on Change in β2-Microglobulin Levels in Hemodiafiltration Patients

A Simple Efficient Technique of ‘Mid-Dilution’ On-Line Hemodiafiltration

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