How to Interpret Intratreatment Changes in Plasma Beta-2-Microglobulin Concentrations

Marsen, Tobias A.; Hönig, R; Schad, Shauna; Barth, C. A.; Pollok, M.; Baldamus, C. A.

doi:10.1159/000417484

Cited by 2 publications

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“…Such assumptions impact on the interpretation of the calculated kinetic parameters for β 2 M, and the lack of accurate methods for routinely measuring the amount of fluid removed from the intracellular and extracellular compartments during therapy has left this issue unresolved. Nonetheless, this concern is legitimate, as others have clearly shown that intradialytic changes in β 2 M concentrations depend on dialysate sodium concentration, presumably by altering the proportion of fluid removed from the intracellular and extracellular compartments (25,26).…”

Section: Kinetics Of β2mmentioning

confidence: 99%

Kinetics of β₂‐Microglobulin and Phosphate during Hemodialysis: Effects of Treatment Frequency and Duration

Leypoldt

2005

Seminars in Dialysis

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Current understanding of beta2-microglobulin (beta2M) and phosphate (or inorganic phosphorus) kinetics during hemodialysis is reviewed. The postdialysis:predialysis concentration ratio for beta2M is determined by dialyzer clearance for beta2M, treatment time, patient body size (specifically, extracellular fluid volume), and total ultrafiltration volume during the treatment. Evaluation of these treatment parameters can be used to calculate dialyzer clearance for beta2M; however, such calculated values are only approximations, since they neglect intradialytic generation, nonrenal (nondialyzer) clearance, and postdialysis rebound of beta2M. The detailed kinetics of beta2M during hemodialysis are best described using a two-compartment model. Theoretical predictions from such two-compartment models suggest that the product of dialyzer clearance for beta2M and weekly treatment duration, independent of treatment frequency, is the main determinant of plasma beta2M concentrations. The kinetics of phosphate removal during hemodialysis are incompletely understood. Phosphate is removed from both extracellular and intracellular compartments during hemodialysis; the plasma phosphate concentration levels off after the first 1 or 2 hours of treatment and plasma concentrations can rebound even before therapy is complete. Increases in dialyzer clearance of phosphate have been previously achieved only by increasing dialysis membrane surface area or by the use of hemodiafiltration. A four-compartment model of phosphate kinetics proposed recently by Spalding et al. suggests that the major barrier to phosphate removal is limited transfer of phosphate between the intracellular and extracellular compartments, although other complex factors also play important roles. Theoretical predictions using the model of Spalding et al. suggest that increasing either treatment frequency or treatment duration can increase phosphate removal. The kinetics of beta2M are representative of middle molecules whose removal during hemodialysis is governed predominantly by clearance at the dialyzer. In contrast, phosphate removal is limited primarily by its sequestration in the intracellular compartment (and possibly other compartments), not by its clearance at the dialyzer. The kinetics of phosphate may therefore be representative of uremic toxins whose removal is limited by sequestration into compartments or by protein binding. Enhanced removal of both of these uremic toxins using a given therapy will require treatments of increased frequency and longer duration.

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Section: Kinetics Of β2mmentioning

confidence: 99%

Kinetics of β₂‐Microglobulin and Phosphate during Hemodialysis: Effects of Treatment Frequency and Duration

Leypoldt

2005

Seminars in Dialysis

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“…Sieving coefficients of ^-microglobulin rar ige from about 0.4-0.8 (12,16,17,19,(22)(23)(24) and te nd to decrease moderately to markedly (16,22,23) 0r remain constant during hemofiltration (24). Interestingly, Asahi polyacrylonitrile (PAN series) seems to be almost impermeable to ^-microglobulin, in contrast to AN69 polyacrylonitrile (16,22,26), which…”

Section: Discussionmentioning

confidence: 99%

In Vivo Clearance and Elimination of Nine Marker Substances during Hemofiltration with Different Membranes

et al. 1992

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The handling of low, middle and high molecular weight markers was examined in seven stable dialysis patients during hemofiltration with different membranes. Four membranes were examined in a randomized, crossover order (polysulfone, polyamide, AN69 polyacrylonitrile, Asahi polyacrylonitrile) by measuring plasma and dialysate concentrations of phosphate, creatinine, vitamin B12, β2-microglobulin, furanic acid, hippuric acid, retinolbinding protein, alpha-1-antitrypsin, and albumin. Sieving coefficients and plasma clearances of β-microglobulin or retinol-binding protein were markedly or slightly lower during hemofiltration with the Asahi polyacrylonitrile membrane than with the other membranes (highest removal with polysulfone/AN69 polyacrylonitrile membranes). No differences of obvious clinical relevance could be seen between the four membranes. A high β2-microglobulin removal rate might be important to prevent dialysis-associated amyloidosis.

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How to Interpret Intratreatment Changes in Plasma Beta-2-Microglobulin Concentrations

Cited by 2 publications

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Kinetics of β₂‐Microglobulin and Phosphate during Hemodialysis: Effects of Treatment Frequency and Duration

Kinetics of β₂‐Microglobulin and Phosphate during Hemodialysis: Effects of Treatment Frequency and Duration

In Vivo Clearance and Elimination of Nine Marker Substances during Hemofiltration with Different Membranes

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How to Interpret Intratreatment Changes in Plasma Beta-2-Microglobulin Concentrations

Cited by 2 publications

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Kinetics of β2‐Microglobulin and Phosphate during Hemodialysis: Effects of Treatment Frequency and Duration

Kinetics of β2‐Microglobulin and Phosphate during Hemodialysis: Effects of Treatment Frequency and Duration

In Vivo Clearance and Elimination of Nine Marker Substances during Hemofiltration with Different Membranes

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Kinetics of β₂‐Microglobulin and Phosphate during Hemodialysis: Effects of Treatment Frequency and Duration

Kinetics of β₂‐Microglobulin and Phosphate during Hemodialysis: Effects of Treatment Frequency and Duration