Beta(2)-microglobulin removal by extracorporeal renal replacement therapies

Biochim Biophys Acta. 2005 Nov 10;1753(1):146-53. doi: 10.1016/j.bbapap.2005.08.008. Epub 2005 Aug 26.

Abstract

There is increasing evidence that end-stage renal disease patients with lower beta(2)-microglobulin plasma levels and patients on convective renal replacement therapy are at lower mortality risk. Therefore, an enhanced beta(2)-microglobulin removal by renal replacement procedures has to be regarded as a contribution to a more adequate dialysis therapy. In contrast to high-flux dialysis, low-flux hemodialysis is not qualified to eliminate substantial amounts of beta(2)-microglobulin. In hemodialysis using modern high-flux dialysis membranes, a beta(2)-microglobulin removal similar to that obtained in hemofiltration or hemodiafiltration can be achieved. Several of these high-flux membranes are protein-leaking, making them suitable only for hemodialysis due to a high albumin loss when used in more convective therapy procedures. On-line hemodiafiltration infusing large substitution fluid volumes represents the most efficient and innovative renal replacement therapy form. To maximize beta(2)-microglobulin removal, modifications of this procedure have been proposed. These modifications ensure safer operating conditions, such as mixed hemodiafiltration, or control albumin loss at maximum purification from beta(2)-microglobulin, such as mid-dilution hemodiafiltration, push/pull hemodiafiltration or programmed filtration. Whether these innovative hemodiafiltration options will become accepted in clinical routine use needs to be proven in future.

Publication types

  • Review

MeSH terms

  • Hemodiafiltration / methods
  • Hemofiltration / methods
  • Humans
  • Renal Dialysis / methods
  • Renal Replacement Therapy / methods*
  • beta 2-Microglobulin / isolation & purification*

Substances

  • beta 2-Microglobulin