The <under>D</under>oubl<under>e</under> Po<under>l</under>ym<under>e</under>thylmethacryla<under>te</under> Filter (DELETE System) in the Removal of Light Chains in Chronic Dialysis Patients with Multiple Myeloma

Abstract

Multiple myeloma (MM) is still one of the most common haematological diseases and is associated with a poor prognosis. It is frequently worsened by acute kidney failure that, in turn, aggravates the risk of death. In the past few years, the idea has made headway that the removal of free light chains (FLC) by means of extracorporeal blood purification systems may facilitate the recovery of renal function. Up to now, many different extracorporeal techniques have been put forward in FLC removal, such as plasma exchange, dialysis with super-flux filters, and adsorption by means of cartridge of resins. In this paper, we illustrate the use of polymethylmethacrylate (PMMA) dialysis membranes with a high adsorptive capacity (Toray BK-F; Toray Industries, Inc., Tokyo, Japan). We have evaluated light chain removal by means of an original dialysis procedure using a double-filter circuit made of PMMA working in sequential dialysis (DELETE system). The system provides satisfactory results in terms of FLC removal and, at the same time, ensures an adequate dialysis treatment (Kt/V >1.5) with significant reduction in urea, creatinine, and β2-microglobulin. The dual PMMA filter system combines an acceptable cost/efficiency ratio when compared with other methods and constitutes a concrete prospect in FLC removal. Its preferential setting of use is in patients with MM or with monoclonal gammopathies, who are on chronic dialysis and maintain high circulating levels of FLC.

Clinical Potentials of Adsorptive Dialysis Membranes

“…Adsorption, however, is an early and saturable process, and is self-limited by the available surface of the membrane. In this issue of Blood Purification , Santoro et al [9] report an ingenious modification of the classical dialysis circuit by using a new double circuit in parallel with a Y-connector. Using this dual circuit with high-flux PMMA filters in a pilot study of 7 patients, these authors report an average reduction rate in both serum FLC κ and λ of 39% (vs. 22% with the classic single-filter system).…”

Removal of free light chains in hemodialysis patients without multiple myeloma: a crossover comparison of three different dialyzers

“…Secondly, this efficacy allows the chronic use of the two dialyzers in chronic dialysis patients when the recovery of multiple myeloma is obtained but not the recovery of renal failure. In this case, use of two PMMA filters for each dialysis session or use of the HFR-Supra is not indicated because of the low light chain values [20, 21]. Thirdly, the polysulfone membrane showed a surprising intrinsic adsorptive ability, recently improved by the technical evolution of this membrane as in the case of polyethersulfone and polyester polymer alloy membrane filters [9, 22].…”

Recent Progress of Microfluidic Devices for Hemodialysis

“…Compared to cellulose membranes, organic synthetic membranes possess more physical-chemical advantages in terms of pore size, hydraulic permeability and filtration capacity. [28,53,[60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75] Polysulfone (PS) [61][62][63][64][65] and polyethersulfone (PES) [66][67][68][69][70] membranes are two of the most classical synthetic membranes, which have been widely used in clinical hemodialysis due to their excellent filtering properties and biocompatibility, thermal stability, mechanical strength, and chemical inertness. However, the intrinsic hydrophobicity of PS membranes often causes the adsorption of serum proteins, leading to serious complications.…”

“…[82][83][84] The heparin-immobilized PLA membrane showed excellent blood compatibility and low toxicity. More recently, Yang and co-workers reported a nontoxic, Small 2020, 16,1904076 [56,57] Modified cellulose membrane Acetate grouped CM Better blood compatibility than CM Limited in clearance of middle [58] Diethylaminoethyl grouped CM molecules and macromolecules [59] Benzyl grouped CM [55] Organic synthetic membrane Polysulfone (PS) Excellent physical and chemical properties; Good mechanical strength; Efficient clearance of middle molecules and macromolecules Lower blood compatibility than biodegradable membrane and protein membrane [61][62][63][64][65] Polyethersulfone (PES) [66][67][68][69][70] Polyamide (PA) [71] Polyacrylonitrile (PAN) [72,73] Poly(methyl methacrylate) (PMMA) [65,74] Polycarbonate (PC) [49] Ethylene-vinyl alcohol copolymer (EVAL) [75] Polyvinylidene Fluoride (PVDF) [28] Polyurethane (PU) [28] Inorganic ultrathin protein membrane with high molecule cleaning efficiency. The protein membrane was fabricated by amyloid-like lysozyme oligomer self-assembly.…”