Β2-Microglobulin AND HAEMODIALYSIS

Shaldon, Stanley; Koch, Karl-Martin; Dinarello, CA; Colton, Clark K.; Knudsen, P.; Floege, Juergen; Granolleras, C.; Bonal, J; Pastor, María Antonia; Romero, R.; Corominas, A; Caralps, A; Mayer, Gert; Thum, J.; Woloszczuk, W.; Graf, Helmut

doi:10.1016/s0140-6736(87)92907-2

Cited by 33 publications

(13 citation statements)

References 8 publications

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“…These studies point to intradialytic body weight changes and to dialyzer pore size as being important factors. These findings, therefore, confirm that membrane contact with cuprophane alone is insufficient to in duce significant degrees of intradialytic ß2M generation and substantiate the suggestion by Shaldon et al [7] to this effect.…”

Section: Discussionsupporting

confidence: 88%

“…Several mechanisms have been held respon sible for this phenomenon; these include hemoconcentration due to ultrafiltration [5], the generation of p2M due to the breakdown of white blood cells as an epiphenomenon related to membrane biocompatibility [2,6] or blood contact with dialysate [7], The hy pothesis relating p2M generation to mem brane biocompatibility expressed as changes in white blood cells seems attractive in view of the finding that a major portion of p2M is present as an intragranular protein in pe ripheral-blood neutrophils [8].…”

mentioning

confidence: 99%

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Intradialytic Body Weight Changes and Dialyzer Pore Size as Main Contributing Factors to the Evolution of Beta-2-Microglobulin in Dialysis

Vanholder

Ringoir

1990

Blood Purif

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Cuprophane hemodialysis is associated with an early fall of leukocyte counts and an intradialytic rise in serum β₂-microglobulin (β₂M), in contrast to dialysis with more compatible dialyzers. It has been suggested that these two phenomena may be related. This study sets out to verify this hypothesis by comparing the evolution of leukocyte counts with that of β₂M: (1) during dialysis with 5 dialyzer types with different pore size and/or leukocyte biocompatibility; (2) during first use and reuse of 3 dialyzer types, and (3) during sequential ultrafiltration and dialysis with cuprophane. In first-use dialyses, no relation could be found between changes in leukocyte counts and the evolution of β₂M levels. Reuse of cuprophane and saponified cellulose ester resulted in a marked attenuation of the intradialytic fall in leukocyte counts after 15 min (change in white blood cell count: -72 and -17% for first-use and third-reuse cuprophane, -72 and -23% for saponified cellulose, respectively), but had no influence on the increase in β₂M. Correlation studies of these data revealed that the intradialytic evolution of β₂M was related to membrane pore size and, for membranes with a small pore size, to the intradialytic fluid losses: first-use cuprophane (p < 0.05), saponified cellulose ester (p < 0.001) and hemophane (p < 0.01), and pooled first-use and reuse cuprophane and saponified cellulose ester (p < 0.001). Cuprophane dialysis without ultrafiltration (dialysate Na⁺: 138 and 132 mEq/1) caused a fall in leukocytes, but induced no rise in β₂M. Ultrafiltration with cuprophane either preceding or following dialysis consistently caused a rise in serum β₂M, although a fall in leukocyte counts only occurred in the first case. Our data point away from a relationship between membrane biocompatibility, expressed as changes in leukocyte counts, and β₂M concentration during hemodialysis. The major contributing factors appear to be dialytic fluid losses and membrane pore size.

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Section: Discussionsupporting

confidence: 88%

mentioning

confidence: 99%

Intradialytic Body Weight Changes and Dialyzer Pore Size as Main Contributing Factors to the Evolution of Beta-2-Microglobulin in Dialysis

Vanholder

Ringoir

1990

Blood Purif

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“…It is well established that in hemodialyzed adults p: M serum levels are elevated [1][2][3]7]. This fact is of great interest regarding the recent description of p2M amyloi dosis in long-term dialytic patients [1,8,9], Despite the unclear relation between p2M serum levels and amyloi dosis risks [7,10], it was speculated that both the lowest level of generation [2,II,12] and the highest level of removal of p2M [5,6,13] in dialytic patients was an important factor for amyloidosis prevention ( fig. 3).…”

Section: Resultsmentioning

confidence: 99%

“…Osmotic cellular stress may be a cause for an en hanced generation rate of |)2M [12]. Although HDF is well tolerated in children, especially those without osmotic syndrome [14], this mode of blood purification leads to high urea clearance for body weight and so theoretically to cellular osmotic stress.…”

Section: Discussionmentioning

confidence: 99%

Beta-2-Microglobulin in Hemodiafiltered Children: Long-Term Efficiency Follow-Up

Fischbach

Hamel

Koehl

et al. 1989

Nephron

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Data of β₂-microglobulin (β₂M) levels are not well known in hemodialyzed children. We analyzed 28 children, all maintained on thrice weekly hemodiafiltration (HDF) with highly permeable membrane (mean age 8 years 7 months, mean time on dialysis 32 months). β₂M is significantly elevated: 34 + 8.5 mg/l without differences for sex but correlated to residual urinary volume. The kinetics of β₂M removal during HDF with different dialysis membranes (polysulfone, polyacrylonitrile), and with the same membrane (polysulfone) used in diffusive (hemodialysis), in convective (hemofiltration) and in diffusive and convective (HDF) modes reveals that polysulfone membranes in HDF mode allow the greatest β₂M serum level drop over dialysis session time (-60 ± 12%). Five children, anuric, mean time on dialysis 75 months (65–94), chronically on thrice weekly (3 × 3 h) HDF with first polyacrylonitrile then polysulfone membranes are investigated regarding β₂M levels and amyloidosis risks. Despite the high removal rate of β₂M with these dialytic modes, β₂M serum levels do not decrease during this five-year study. High β₂M serum extraction seems to be compensated by high β₂M cell generation. Further investigation is necessary for the explanation of the presumed high β₂M generation rate in the HDF with polysulfone membranes before recommendation of safe long-term use of such highly permeable membranes for prevention of amyloidosis risks in dialytic patients.

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“…In vitro, the evi dence for the former hypothesis is contradictory [34][35][36][37][38], Whether the rise in serum |TM levels during CUP HD can be attributed solely to fluid shifts is also uncertain. When p2M concentrations are adjusted for intradialytic changes in plasma volume, increases in concentration of this pro tein of between 10 and 40% have been reported [7,[39][40][41][42][43][44][45][46][47][48][49][50]. However, as free (TM is distributed in the total extra cellular water, Bergstrom and Wehle [18] have argued that it is more appropriate to correct serum p2M levels for ultrafiltration by estimating changes in ECV.…”

Section: Discussionmentioning

confidence: 99%

Effect of Dialyzer Reprocessing with Renalin on Serum Beta-2-Microglobulin and Complement Activation in Hemodialysis Patients

Westhuyzen¹,

Foreman

Battistutta

et al. 1992

Am J Nephrol

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The peracetic acid-based sterilant Renalin® is increasingly being used for reprocessing hemodialyzers. In order to evaluate the effects of reprocessing on (32-microglobulin (β₂M) kinetics and complement activation in chronic hemodialysis patients, we compared 4 dialyzer membranes on 1st, 2nd and 4th use of the membrane. Dialysis with new cuprammonium rayon dialyzers (0.8 m²) for 4 h resulted in a nonsignificant increase in serum β₂M concentrations of 10.7% (corrected for changes in extracellular volume) and significant generation of the complement component C3a des Arg. On reuse, minimal changes in serum β₂M levels were noted and complement activation was absent. Dialysis with new cellulose acetate (CA, 1.5 m²), polyacrylonitrile (AN69 HF, 1.6 m²) or polymethylmethacrylate (PMMA, 1.6 m²) membranes resulted in significant decreases in serum β₂M levels (19.5, 31.7 and 50.8%, respectively). Reprocessing had negligible effects on the removal of β₂M by CA and AN69, but by the 4th use halved the effectiveness of PMMA. Reprocessing reduced the significant generation of C3a des Arg observed with new CA and PMMA membranes. We conclude that, except for PMMA, Renalin reprocessing has minor effects on the ability of the membranes to remove β₂M and improves the biocompatibility of all membranes studied.

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Β2-Microglobulin AND HAEMODIALYSIS

Cited by 33 publications

References 8 publications

Intradialytic Body Weight Changes and Dialyzer Pore Size as Main Contributing Factors to the Evolution of Beta-2-Microglobulin in Dialysis

Intradialytic Body Weight Changes and Dialyzer Pore Size as Main Contributing Factors to the Evolution of Beta-2-Microglobulin in Dialysis

Beta-2-Microglobulin in Hemodiafiltered Children: Long-Term Efficiency Follow-Up

Effect of Dialyzer Reprocessing with Renalin on Serum Beta-2-Microglobulin and Complement Activation in Hemodialysis Patients

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