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Membrane flux not biocompatibility determines beta-2-microglobulin levels in hemodialysis patients
Thomas M Pickett1, Alastair Cruickshank, Roger N Greenwood
1Directorate of Medicine, Gloucestershire Royal Hospital, Gloucester, UK.
Background:
Serum beta(2)-microglobulin (beta(2)M) levels are important in dialysis-related amyloid deposition but can be influenced by dialysis technique.
Methods:
We measured beta(2)M levels in 3 centres using different dialysis regimes. Centre 1 (73 patients) used high-flux biocompatible, centre 2 (72 patients) low-flux biocompatible and centre 3 (142 patients) cuprophane dialysers.
Results:
beta(2)M levels were lower with high-flux biocompatible than with low-flux biocompatible or cuprophane dialysis (22.3 +/- 5.4 vs. 43.4 +/-13.7 and 37.6 +/-13.1 mg/l, respectively; p < 0.001). Levels were higher with low-flux biocompatible than with cuprophane dialysis (p < 0.001), but not if patients dialysed over 10 years were excluded. With low-flux biocompatible (47.4 +/- 9.8 vs. 38.7 +/- 15.2 mg/l; p < 0.01) and cuprophane dialysis (43.4 +/- 8.2 vs. 36.7 +/- 13.0 mg/l; p < 0.02), beta(2)M levels were higher in patients dialysed over 5 years than in those dialysed less. Despite beta(2)M levels increasing as residual renal function declined, there was no similar rise with high-flux biocompatible dialysis.
Conclusions:
Techniques allowing significant convection maintain lower beta(2)M levels over many years. Membrane flux, not biocompatibility, is the main determinant of beta(2)M levels in routine practice.