Effect of protein leaking BK-F PMMA-based hemodialysis on plasma pentosidine levels.
BACKGROUND
Advanced glycation end-products (AGEs) are now considered to contribute to the middle molecule toxicity of uremia and, because they are not cleared by conventional low-flux hemodialysis, alternative strategies are needed to improve their removal.


METHODS
In a prospective cross-over trial involving 18 adult chronic hemodialysis subjects, we evaluated the intradialytic removal and the long-term effect on predialysis levels of Protein-bound (PBPe) and Free (FPe) pentosidine by high-pore, protein-leaking BK-F Polymethylmethacrylate-based hemodialysis (BK-F-HD), by comparing it to hemodialysis using low-flux dialyzers (LF-HD).


RESULTS
A single BK-F-HD session removed more PBPe, but not FPe, than LF-HD. Long-term BK-F-HD was associated with a significant decrease in pre-dialysis PBPe, FPe, and albumin (17.7 +/- 20.8, 25.3 +/- 17.3 and 8.0 +/- 3.3%, p<0.01) and no change in body mass index and protein catabolic rate, compared to LF-HD. Multiple stepwise regression analysis identified C-reactive Protein (CRP) (standardized beta coefficient=-0.629), pre-dialysis levels in LF-HD (beta=0.452) and dialysis vintage (beta=0.428) as significant determinants of BK-F-induced changes in predialysis PBPe, and predialysis FPe and PBPe levels in LF-HD as significant determinants of BK-F-induced changes in predialysis FPe (beta=0.720 and 0.286, respectively).


CONCLUSIONS
Our study shows that long-term standard diffusive hemodialysis with BK-F membrane reduces predialysis PBPe and FPe levels by comparison with LF-HD, largely due to a greater intradialytic clearance of PBPe. Serum albumin is also reduced without any associated changes in nutritional status markers. The study also suggests that the effect of BK-F-HD in lowering PBPe levels is modulated by the body burden of pentosidine and is blunted or even lost in the presence of elevated CRP levels.
Tessitore
Nicola
N
Nephrology Division, Università degli Studi di Verona, Azienda Ospedaliera of Verona, Italy. nicola.tessitore@azosp.vr.it
Lapolla
Annunziata
A
Aricò
Nadia Concetta
NC
Poli
Albino
A
Gammaro
Linda
L
Bassi
Antonella
A
Bedogna
Valeria
V
Corgnati
Angela
A
Reitano
Rachele
R
Fedele
Domenico
D
Lupo
Antonio
A
D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood*; D001798:Blood Proteins / Q000378:metabolism; D018592:Cross-Over Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy*; D008239:Lysine / Q000031:analogs & derivatives* / Q000097:blood*; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D019904:Polymethyl Methacrylate; D011446:Prospective Studies; D011485:Protein Binding; D006435:Renal Dialysis / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome
D001798:Blood Proteins; D008567:Membranes, Artificial; D019904:Polymethyl Methacrylate; D001120:Arginine; C062187:pentosidine; D008239:Lysine