Kinetic and clinical studies of beta 2-microglobulin in continuous ambulatory peritoneal dialysis: influence of renal and enhanced peritoneal clearances using glucose polymer.
A risk of beta 2-microglobulin (beta 2-M)-associated amyloidosis in long-term CAPD patients has been recognised. We examined the kinetics of beta 2-M and potential clinical manifestations of amyloidosis in patients well-established on CAPD for 1-76 months (mean +/- SEM; 16.4 +/- 14 months). In 57 patients, serum beta 2-M concentration was elevated to 30 +/- 1.8 (mean +/- SEM, mg/l) and correlated positively with the duration on CAPD. In 18 patients studied with variable degrees of residual renal function, serum beta 2-M concentration increased with declining renal function; this was most marked when the creatinine clearance was less than 1 ml/min. Using an isosmolar solution (302 +/- 1.3 mOsm/kg) containing 5% glucose polymer (9.4 mmol/l; MW 16,800), the transperitoneal elimination of beta 2-M was significantly enhanced (1.6 times) compared to conventional 1.36% glucose solution, but without a detectable change in serum concentrations during a 6-h study. No significant difference was found between the estimated minimum volume of distribution of beta 2-M in CAPD and haemodialysis patients. Symptomatic amyloid-associated disease was absent in patients in this study, and may be attributed to the short duration of dialysis.
Mistry
C D
CD
Department of Renal Medicine, Manchester Royal Infirmary, UK.
O'Donoghue
D J
DJ
Nelson
S
S
Gokal
R
R
Ballardie
F W
FW
D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000097:blood / Q000188:drug therapy / Q000209:etiology; D001202:Ascitic Fluid / Q000378:metabolism*; D005260:Female; D005936:Glucans / Q000378:metabolism*; D006801:Humans; D007668:Kidney / Q000378:metabolism*; D016030:Kidney Transplantation / Q000502:physiology; D007700:Kinetics; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D014462:Ultrafiltration; D001613:beta 2-Microglobulin / Q000032:analysis / Q000378:metabolism*
D005936:Glucans; D001613:beta 2-Microglobulin