title: Hemodiafiltration improves free light chain removal and normalizes κ/λ ratio in hemodialysis patients.
abstract: OBJECTIVE
  Serum free light chain (FLC) levels are correlated with chronic kidney disease (CKD) stages and are highest in patients on hemodialysis (HD). Aim of this study was to assess the FLC removal efficiency of Elisio™-210H dialyzer using either high-flux HD or on line high efficiency hemodiafiltration (HDF) modalities in CKD-5D patients.
  
  
  METHODS
  In this prospective and comparative study, 20 CKD-5D patients free from multiple myeloma were randomized in two groups: HD versus on line HDF. All patients were dialyzed with Elisio™-210H dialyzer. Serum samples were collected before and after the midweek dialysis session, before randomization and at the end of the study to measure κ and λ FLC concentrations. Reduction ratios were corrected for net ultrafiltration.
  
  
  RESULTS
  For both HD and HDF mode, κ and λ FLC concentrations were significantly lower after dialysis than before but median reductions in κ and λ FLC levels were significantly higher in HDF versus HD groups (κ 73.5 vs. 65.5 %, p = 0.04 and λ 51.0 vs. 36.6 %, p = 0.07). After dialysis, all κ/λ ratio values were between 0.26 and 1.65 which is the reference range described in subjects with normal kidney function, for both HD and HDF groups (median κ/λ ratios were 0.80 [0.47-1.22] and 0.67 [0.50-0.79] respectively).
  
  
  CONCLUSIONS
  This study shows the superiority of on line HDF compared with HD to remove both κ and λ FLC. Moreover, all post-dialysis κ/λ ratios reached normal reference range.
authors.affiliation: Laboratoire de Biochimie-Hôpital Lapeyronie, CHRU Montpellier, 371, Avenue du Doyen Gaston Giraud, 34000, Montpellier, France.
authors.forename: Chloé
authors.initials: C
authors.lastname: Bourguignon
authors.affiliation: Service de Néphrologie-Hémodialyse et Soins Intensifs, CHRU, 34000, Montpellier, France.
authors.forename: Leïla
authors.initials: L
authors.lastname: Chenine
authors.affiliation: Laboratoire de Biochimie-Hôpital Lapeyronie, CHRU Montpellier, 371, Avenue du Doyen Gaston Giraud, 34000, Montpellier, France.|U1046 INSERM, UMR9214 CNRS Univ Montpellier, 34000, Montpellier, France.
authors.forename: Anne Sophie
authors.initials: AS
authors.lastname: Bargnoux
authors.affiliation: Service de Néphrologie-Hémodialyse et Soins Intensifs, CHRU, 34000, Montpellier, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Leray-Moragues
authors.affiliation: Institut de Recherche et de Formation en Dialyse, CHRU Montpellier, 34000, Montpellier, France.|Université de Montpellier, 34000, Montpellier, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Canaud
authors.affiliation: Laboratoire de Biochimie-Hôpital Lapeyronie, CHRU Montpellier, 371, Avenue du Doyen Gaston Giraud, 34000, Montpellier, France. jp-cristol@chu-montpellier.fr.|U1046 INSERM, UMR9214 CNRS Univ Montpellier, 34000, Montpellier, France. jp-cristol@chu-montpellier.fr.|Institut de Recherche et de Formation en Dialyse, CHRU Montpellier, 34000, Montpellier, France. jp-cristol@chu-montpellier.fr.|Université de Montpellier, 34000, Montpellier, France. jp-cristol@chu-montpellier.fr.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Cristol
authors.affiliation: Laboratoire de Biochimie-Hôpital Lapeyronie, CHRU Montpellier, 371, Avenue du Doyen Gaston Giraud, 34000, Montpellier, France.|U1046 INSERM, UMR9214 CNRS Univ Montpellier, 34000, Montpellier, France.|Institut de Recherche et de Formation en Dialyse, CHRU Montpellier, 34000, Montpellier, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Morena
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005602:France; D017583:Hemodiafiltration / Q000295:instrumentation; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000097:blood*; D007145:Immunoglobulin kappa-Chains / Q000097:blood*; D007146:Immunoglobulin lambda-Chains / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D007147:Immunoglobulin Light Chains; D007145:Immunoglobulin kappa-Chains; D007146:Immunoglobulin lambda-Chains
keywords: CKD; HDF; Internal convection HD; Serum free light chain removal