High-Flux Hemodialysis Postpones Clinical Manifestation of Dialysis-Related Amyloidosis

Abstract

Amyloidosis due to the retention of β₂-microgιobulin (β₂-MG) is a frequent complication of hemodialysis (HD). Significant amounts of β₂-MG can be removed from the body by highly permeable HD membranes, whereas conventional low-flux membranes are impermeable for the molecule. In a prospective and controlled study we investigated whether high-flux HD could delay the onset of dialysis-related amyloidosis (DRA). Twenty patients treated with cuprophane low-flux HD membranes were matched for age and previous time on HD either to continue their HD regimen or to receive HD treatment with high-flux polysulfone membranes. For 6 years each patient was examined for manifestations of DRA once a year or upon individual needs, additionally, serum β₂-MG levels were monitored. After 6 years of follow-up no clinical signs of DRA were found in any of the patients dialyzed with high-flux polysulfone membranes, whereas 8/10 of the conventionally dialyzed patients had CTS and/or osteoarticular lesions. Serum levels of β₂-MG were significantly reduced in patients treated with high-flux polysulfone membranes.

Carpal Tunnel Surgery as Proxy for Dialysis-Related Amyloidosis: Results from the Japanese Society for Dialysis Therapy

“…Although age, dialysis vintage, and genetic factors are naturally unchangeable, many attempts have been made to reduce chronic inflammation and oxidant stress, which have been considered treatable risk factors. It was reported that dialysis with a polysulfone membrane, rather than with cuprofan, may decrease the risk of new DRA since polysulfone is biocompatible [6,27,28]. Moreover, use of lower contamination of endotoxin dialysis solutions was reported to decrease the incidence of onset of CTS [29].…”

Long-Term Outcomes in Online Hemodiafiltration and High-Flux Hemodialysis

“…HDF has been demonstrated to be a superior provider of middle molecule clearance (3)(4)(5). Observational studies have suggested that increased ␤2 microglobulin clearance by high-flux HD is associated with reduced incidence of dialysis-related amyloidosis compared with low-flux HD (6,7). Compelling data from the Membrane Permeability Outcome Study (8) suggest that highflux HD provides a survival benefit compared with low-flux HD, at least in patients with low serum albumin.…”

Effectiveness of β₂-Microglobulin Adsorption Column in Treating Dialysis-Related Amyloidosis: A Multicenter Study

“…It was reported that treatment with a high-flux dialyzer and a low-contaminant dialysis fluid yielded a lower β 2 m level and inhibited the onset of bone cysts compared with conventional HD [14,15,16]. Gejyo et al [4] reported an increase in number of bone cysts in a group given HD alone, but no additional formation of bone cysts in a group treated with Lixelle for 2 years.…”