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β 2 -Microglobulin Removal and Plasma Albumin Levels with High Cut-off Hemodialysis

2007; SAGE Publishing; Volume: 30; Issue: 5 Linguagem: Inglês

10.1177/039139880703000505

1724-6040

Michael Haase, Rinaldo Bellomo, Ian T. Baldwin, Anja Haase‐Fielitz, Nigel Fealy, Stanislao Morgera, H. Goehl, Markus Storr, Neil Boyce, H.-H. Neumayer,

Acute Kidney Injury Research

Purpose. β 2 -microglobulin (β 2 MG) is pivotal to the pathogenesis of dialysis-related amyloidosis. We compared the effects of high cut-off hemodialysis (HCO-HD) with those of standard high-flux hemodialysis (HF-HD) regarding the concentration and clearance of β 2 MG and albumin. Design. We enrolled ten patients with acute renal failure in a double-blind, cross-over, randomized controlled trial. Procedures Each patient received four hours of HCO-HD (estimated in vivo cutoff 50–60 kDa) and four hours of HF-HD (estimated in vivo cutoff 15–20 kDa) in random order. Statistical methods and outcome measures: As data lacked normal distribution, we used non-parametric statistical analysis. Plasma and dialysate concentrations of β 2 MG and albumin were measured at baseline and after four hours of each study treatment. Main findings. We found significantly greater diffusive β 2 MG clearances for HCO-HD compared to HF-HD (at the start: 71.8 ml/min vs. 5.1 ml/min; P=0.008 and at the end: 68.8 ml/min vs. 5.7 ml/min; P=0.008). We found a reduction in plasma β 2 MG concentrations of -31.6% during HCO-HD compared to an increase by 25.7% during HF-HD; P=0.008. At baseline (HCO-HD: 26.0 g/L vs. HF-HD: 26.5 g/L), and at the end of both treatments, plasma albumin concentrations were comparable (HCO-HD: 25.5 g/L vs. HF-HD: 26.5 g/L; P=0.25). During HCO-HD, albumin clearance was 1.9 ml/min at the start and decreased significantly to 0.8 ml/min at the end; P=0.008. HF-HD had an albumin clearance of 0.01 ml/min. Conclusions. HCO-HD was more effective in decreasing plasma β 2 MG concentrations than standard HF-HD and did not reduce plasma albumin levels. Further studies of HCO-HD in the treatment of dialysis-related β 2 MG accumulation appear warranted. ( ClinicalTrials.gov number, NCT00333593 [ ClinicalTrials.gov ]) (Int J Artif Organs 2007; 30: 385–92)