The Effect of High-Flux Hemodialysis on Dialysis-Associated Amyloidosis

Abstract

Amyloidosis is an important cause of mortality and morbidity in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). In this study, depending on the idea that the clearance of middle and high molecular weight toxins could be improved, we aimed to investigate the effect of high-flux dialyzer on clearance of beta-2 microglobulin (beta2-MG) and calcium (Ca) phosphorus (P) metabolism in patients under HD treatment. Forty-eight patients with ESRD under chronic HD treatment were included in the study. All patients were randomized into two groups, and HD was performed with low-flux or high-flux dialyzer for 6 months. In the high-flux group, the reduction of beta2-MG and P levels during dialysis was significantly higher when compared with the low-flux group (p<0.001). During the follow-up period, while beta2-MG levels decreased significantly in the high-flux group (p<0.05), there was an increase in the low-flux group (p<0.05). As a result, our findings suggest that use of high-flux dialyzer can be an efficient alternative in terms of controlling the clearance of beta2-MG and impaired Ca and P metabolism. These beneficial effects of high-flux dialyzers are probably mediated by the improved clearance of middle and high molecular weight toxins.

Influence of Dialysis Modality and Membrane Flux on Quality of Life in Hemodialysis Patients

“…Well-randomized prospective studies did not prove significant differences in hematological parameters, no matter if the patients were treated by low- 31,32 Other studies, which included patients with Epo therapy, showed that in the high-flux dialysis group Epo doses were significantly lower and Hb levels showed a significant increase compared with the low-flux dialysis group, where Hb levels showed no significant increase, despite the steady increase in Epo doses. 33 When the SF-36 domains were analyzed, the lowest values were observed in role physical, physical function, and general health domains in all groups, which is in accordance with results of previous studies in HD patients. [34][35][36][37][38] Mental health and bodily pain were the least impaired.…”

The Effect of High-Flux Hemodialysis on Hemoglobin Concentrations in Patients with CKD

“…However, our negative results are in contrast with some other reports (9,10). In those studies the investigators found a positive effect on hemoglobin levels between patients treated with a high-flux membrane and those undergoing standard dialysis.…”

“…In the randomized study from Ayli and coworkers, the sample size seemed to be rather small (the study included only 48 patients) with a study period of only 6 months (9). In addition, the study patients were anemic (hemoglobin ,11 g/dl) and did not respond to ESA therapy (9). In contrast, in our study, 131 patients (63 undergoing low-flux and 68 undergoing high-flux dialysis) completed the trial according to the protocol and were studied for 1 year.…”

“…These "high-flux" membranes also eliminate molecules of medium molecular weight that accumulate in renal failure and that have been suggested as causing adverse effects on erythropoiesis (9). However, various clinical studies aiming to demonstrate the superiority of high-flux over low-flux membranes for renal anemia have delivered conflicting results (9)(10)(11)(12)(13). Consequently, it remains unclear whether and how the removal of higher-molecular-weight molecules would benefit hemoglobin levels.…”

Clinical outcomes for maintenance hemodialysis patients using a high-flux (FX60) dialyzer

“…17 In addition, anemia persists in 20% to 30% of cases despite erythropoietin (EPO) treatment. Adequate dialysis can contribute to a correction of anemia via many mechanisms, 18,19 including the removal of molecules that may inhibit erythropoiesis. One of the aims of this study, which was based on the idea that the clearance of moderate and high molecular weight erythropoiesis inhibitors, such as b2-MG, parathyroid hormone, NT-proBNP and so on, leads to an improvement of anemia, was to investigate the effect of high-flux dialysis on anemia and EPO requirement (number of erythropoietin doses per week) in patients undergoing HD.…”