Comparison of Free Light Chain Removal by Four Blood Purification Methods

Abstract

Renal failure is a frequent complication in patients with multiple myeloma. Immunoglobulin free light chains (FLCs) form casts in the distal tubules, resulting in renal obstruction, and are also directly toxic to proximal renal tubules. Removal of FLCs contributes to renal recovery. High cut-off (HCO) membrane Theralite2100, protein leaking dialyzer PES210Dα, plasma separator Evacure1A20 and β(2) microglobulin adsorption column LixelleS-35 were compared in their FLC removal rate. Dialysis using Theralite2100 or Evacure1A20, diafiltration using PES210Dα and adsorption using LixelleS-35 were performed in an in vitro circuit. The highest removal rate was obtained by Theralite2100 dialysis among the four blood purification methods. Albumin loss was also the greatest in Theralite2100 dialysis. The removal content of FLCs per 1 g albumin loss was better in PES210Dα diafiltration. The removal rate of FLCs by Evacure EC1A-20 dialysis was the third highest. Adsorption of FLCs by the β(2) microglobulin adsorption column Lixelle S-35 was confirmed. In conclusion, Theralite2100 dialysis was the best in removal of FLCs. PES210Dα diafiltration can remove FLCs with smaller loss of albumin.

Delayed recovery of kidney function in a multiple myeloma patient treated with high cut-off hemodialysis: A case report

“…Currently, high cut-off dialysis is the most efficient method of removing FLC [7]. High cut-off dialyzer has a membrane with large pores, with a permeability for substances with molecular weights up to 45 kD.…”

Hemodialysis Using High Cut Off Filters in Light Chain Cast Nephropathy

“…The Theralite ® 2100 seems to be one of the most efficient filters in removal of LC, although this is at a price of a considerable loss of albumin [9,10] . We only assessed filter effectiveness in 1 patient, but found a clearance rate similar to what has been previously reported [9,10] . A low LC removal rate and apparently ineffective HCO dialysis can relate to the chemical composition of LC.…”

“…This is in accordance with our observations in the historic control group. Highly permeable protein-leaking membranes can filter large amounts of LC and, in combination with an extended hemodialysis time, have proven effective in terms of LC removal [9,10] . The Theralite ® 2100 seems to be one of the most efficient filters in removal of LC, although this is at a price of a considerable loss of albumin [9,10] .…”

“…Highly permeable protein-leaking membranes can filter large amounts of LC and, in combination with an extended hemodialysis time, have proven effective in terms of LC removal [9,10] . The Theralite ® 2100 seems to be one of the most efficient filters in removal of LC, although this is at a price of a considerable loss of albumin [9,10] . We only assessed filter effectiveness in 1 patient, but found a clearance rate similar to what has been previously reported [9,10] .…”

“…The development of highly permeable dialysis (high cutoff (HCO)) filters allows the removal of both kappa and lambda FLC (molecular weight 22.5 and 45 kDa, respectively) [9,10] , and previous studies using extended HCO dialysis have demonstrated improved renal outcome [11,12] . Clinical practice demonstrates huge variations in the FLC production between patients and the amount of LC being removed with HCO dialysis varies considerably.…”