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Influence of various hemodialysis membranes on the plasma (1-->3)-beta-D-glucan level
1Department of Internal Medicine, University of Tokyo, Tokyo, Japan. hkanda-tky@umin.ac.jp
Background:
Recently, invasive fungal infections have increased significantly because of the growing number of immunocompromised hosts. The measurement of plasma (1-->3)-beta-D-glucan has been proposed as a useful diagnostic tool for deep mycosis. In this study, we analyzed the alteration of the plasma (1-->3)-beta-D-glucan concentration by using different kinds of hemodialysis (HD) membranes in end-stage renal disease (ESRD) patients and estimated its half-life.
Methods:
Twenty-seven patients with ESRD without known fungal infections (with a median age of 66 years old) were enrolled in this study. Cellulose triacetate (CTA) membrane, cellulose (Cu) membrane, and polymethyl methacrylate (PMMA) membrane were used in three consecutive initiations of HD and plasma (1-->3)-beta-D-glucan concentration was measured before and after each HD session.
Results:
The level did not change between before and after HD when CTA and PMMA membranes were used. In contrast, the plasma (1-->3)-beta-D-glucan level increased greatly after HD using the Cu membrane (from 9.4 to 332 pg/mL in median). Hypothesizing that the plasma (1-->3)-beta-D-glucan level declines exponentially, its median half-life is estimated at 20 hours, which is not affected by hepatic or renal function.
Conclusions:
Because the plasma (1-->3)-beta-D-glucan level increases dramatically after HD using the Cu membrane, dialyzers with Cu membrane should be avoided for HD in patients with suspected deep mycosis. The measurement of plasma (1-->3)-beta-D-glucan is also useful for the patients with hepatic or renal failure.
Insights
Plasma (1-->3)-beta-D-glucan levels increase with cellulose (Cu) hemodialysis membranes, suggesting these should be avoided in patients with suspected fungal infections. The diagnostic marker’s half-life is approximately 20 hours.
Area of Science:
- Clinical Chemistry
- Nephrology
- Mycology
Background:
- Invasive fungal infections are rising in immunocompromised individuals.
- Plasma (1-->3)-beta-D-glucan is a proposed diagnostic marker for deep mycosis.
- Hemodialysis (HD) may affect (1-->3)-beta-D-glucan levels in end-stage renal disease (ESRD) patients.
Purpose of the Study:
- To analyze plasma (1-->3)-beta-D-glucan concentration changes using different hemodialysis membranes in ESRD patients.
- To estimate the half-life of plasma (1-->3)-beta-D-glucan.
Main Methods:
- Twenty-seven ESRD patients (median age 66) underwent HD with cellulose triacetate (CTA), cellulose (Cu), or polymethyl methacrylate (PMMA) membranes.
- Plasma (1-->3)-beta-D-glucan was measured before and after each HD session.
- Half-life was estimated assuming exponential decline.
Main Results:
- No significant change in (1-->3)-beta-D-glucan levels with CTA or PMMA membranes.
- A significant increase in (1-->3)-beta-D-glucan levels after HD with Cu membrane (median 9.4 to 332 pg/mL).
- Estimated median half-life of plasma (1-->3)-beta-D-glucan is 20 hours, independent of hepatic or renal function.
Conclusions:
- Hemodialyzers with Cu membranes should be avoided in ESRD patients with suspected deep mycosis due to dramatic (1-->3)-beta-D-glucan level increases.
- Plasma (1-->3)-beta-D-glucan measurement is valuable for patients with hepatic or renal failure.
- The study highlights the impact of dialysis membrane material on diagnostic marker levels.