Efficient Removal of Albumin-Bound Furancarboxylic Acid by Protein-Leaking Hemodialysis

Abstract

Furancarboxylic acid (3-carboxy-4-methyl-5-propyl-2-furanpropionic acid, CMPF), an inhibitor of erythropoiesis, cannot be removed by conventional hemodialysis due to its strong albumin binding, resulting in its accumulation in uremic serum. We used protein-leaking hemodialysis with BK-F dialyzers in 8 uremic patients for 4 months to determine its effect on the serum levels of CMPF. Pre-hemodialysis serum levels of CMPF significantly decreased to about 50% after 4 months by protein-leaking hemodialysis, while those of BUN and serum creatinine did not change significantly. Pre-hemodialysis hematocrit and hemoglobin levels significantly increased by protein-leaking hemodialysis. These results indicate that protein-leaking hemodialysis reduces serum levels of albumin-bound CMPF and improves anemia.

Protein-Leaking Membranes for Hemodialysis

“…Studies that have been conducted with protein-leaking membranes (Table 2) have used changes in some biochemical marker, rather than a clinical outcome, as the primary end point. Seven studies have been reported in full manuscript form (33)(34)(35)(36)(37)(38)(39)(40).…”

“…Uremic toxins with an effective molecular weight in the 30-to 70-kD range may contribute to erythropoietin resistance (33,41). 3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF) is Ͼ98% bound to albumin and has been reported to inhibit erythropoiesis (33). In an observational study, Niwa et al (33) examined the effects of high-flux hemodialysis with a protein-leaking polymethylmethacrylate membrane (BK-F; Toray, Tokyo, Japan) on serum levels of CMPF in eight patients who were treated previously with low-flux cellulose membranes and had hematocrits Ͻ27%.…”

“…3-Carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF) is Ͼ98% bound to albumin and has been reported to inhibit erythropoiesis (33). In an observational study, Niwa et al (33) examined the effects of high-flux hemodialysis with a protein-leaking polymethylmethacrylate membrane (BK-F; Toray, Tokyo, Japan) on serum levels of CMPF in eight patients who were treated previously with low-flux cellulose membranes and had hematocrits Ͻ27%. Serum levels of CMPF were 10-fold greater than normal at entry to the study and decreased by 51% over 4 mo of treatment with the protein-leaking membrane; 2.8 Ϯ 1.0 mg of CMPF was recovered in the dialysate with the protein-leaking membrane compared with 0.1 Ϯ 0.1 mg with the low-flux membrane.…”

“…If use of protein-leaking membranes were also accompanied by a change to ultrapure dialysate, then the ultrapure dialysate rather than the protein-leaking membrane might explain the improved responsiveness to erythropoietin. No information on dialysate quality is available for the studies reported so far (33,34,38).…”

A new polymethylmetacrylate membrane improves the membrane adhesion of blood components and clinical efficacy

“…9). Previous articles have reported the improvements of various clinical symptoms with the conventional PMMA dialyzers [3][4][5][9][10][11][12][13][14][15][16][17][18][19]. Protein adsorption by PMMA membranes is considered one factor associated with these improvements.…”