[Middle molecules removal. Beyond beta2-microglobulin].
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.
Maduell
F
F
Servicio de Nefrología, Hospital General de Castellón. maduell_fra@gva.es
Sánchez-Canel
J J
JJ
Blasco
J A
JA
Navarro
V
V
Ríus
A
A
Torregrosa
E
E
Pin
M T
MT
Cruz
C
C
Ferrero
J A
JA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000510:Alpha-Globulins / Q000032:analysis; D003404:Creatinine / Q000032:analysis; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D008297:Male; D008875:Middle Aged; D009211:Myoglobin / Q000032:analysis; D011388:Prolactin / Q000032:analysis; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D014508:Urea; D001613:beta 2-Microglobulin / Q000032:analysis*
D000510:Alpha-Globulins; D009211:Myoglobin; C016001:alpha-1-microglobulin; D001613:beta 2-Microglobulin; D014508:Urea; D011388:Prolactin; D003404:Creatinine