[Middle molecules removal. Beyond beta2-microglobulin]

Nefrologia. 2006;26(4):469-75.
[Article in Spanish]

Abstract

The uremic toxin removal capacity mainly depends on dialyzer and hemodialysis modes. The low-flux hemodialysis only removes solutes having molecular weights less than 5.000 Da. High-flux hemodyalisis represents a form of low-volume hemodiafiltration because of the internal filtration and back-filtration that can take place within a dialyzer. Hemodiafiltration with large volumes of replacement fluid seems to be the best technique for removing all small, medium-sized and large molecules. The objective of our study was to evaluate the large molecules removal bigger than beta2-microglobuline on high flux haemodialysis and on-line hemodiafiltration with postdilutional infusion, in patients with three times a week dialysis and on short daily dialysis. We studied 24 patients, 15 males and 9 females stable on haemodialysis programme, twelve on standard four to five hours three times a week dialysis and twelve on 2 to 2 1/2 hours six times a week dialysis. All patients were dialysed with Fresenius 4008 monitor, three sessions on high flux haemodialysis (HD) and three sessions on on-line hemodiafiltration (OL-HDF). Two sessions with each filter were performed (polisulfone HF80, polyethersulfone Arylane H9 and new polisulfone APS 900). Pre and postdialysis concentrations of urea, creatinine, (beta2-microglobulin (beta2-m), myoglobin, prolactin and alpha1 microglobulin (alpha1-m) were measured. There was no difference in urea and creatinine small molecules removal. beta2m removal was 68% on HD and 81% on OL-HDF. Myoglobin and prolactin present a similar removal pattern, a higher removal with new filters (60% with Arylane and 59% with APS) in comparison with clasical polisulfone (22% with HF80). The mean alpha1-m reduction rate on HD was 6% and on OL-HDF 22%. OL-HDF with APS 900 filter was the most remove technique (35.4%), significatively higher than the other modes and filters. We can conclude that the new filters generation reach a better uremic toxins removal, specially in large molecules higher than beta2-m and on HD modality.

Publication types

  • Comparative Study
  • English Abstract

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Alpha-Globulins / analysis
  • Creatinine / analysis
  • Female
  • Hemodiafiltration*
  • Humans
  • Male
  • Middle Aged
  • Myoglobin / analysis
  • Prolactin / analysis
  • Prospective Studies
  • Renal Dialysis / methods*
  • Urea
  • beta 2-Microglobulin / analysis*

Substances

  • Alpha-Globulins
  • Myoglobin
  • alpha-1-microglobulin
  • beta 2-Microglobulin
  • Urea
  • Prolactin
  • Creatinine