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Influence of haemodialysis membranes on beta 2-microglobulin kinetics: in vivo and in vitro studies
1INSERM U 90, Hôpital Necker, France.
Abstract:
Amyloidosis of the beta 2-microglobulin (beta 2M) type is a recently recognised complication of dialysis. We studied plasma and ultrafiltrate beta 2M in 36 chronic haemodialysis patients. Long-term dialysis with standard cuprophan membrane in non-oliguric patients and with the AN69 polyacrylonitrile membrane in oliguric patients resulted in lower plasma beta 2M concentrations (means +/- SD, 24.4 +/- 6.6 and 33.0 +/- 8.2 micrograms/ml, respectively) than with cuprophan in oliguric patients (47.0 +/- 13.2 micrograms/ml, P less than 0.01). In acute studies, plasma beta 2M (corrected for haemo-concentration) increased, although not significantly, during cuprophan dialysis (n = 10) from 40.6 +/- 12.2 to 44.8 +/- 7.6 micrograms/ml and decreased during AN69 dialysis (n = 10) from 39.4 +/- 18.0 to 24.3 +/- 7.1 micrograms/ml (P less than 0.02). After 15 min ultrafiltration, beta 2M sieving coefficient in vivo was 0.33 for AN69 but near zero for cuprophan. Total mass transfer of beta 2M across the AN69 membrane during a 4-h dialysis was 142 +/- 45.8 mg (n = 7). AN69, but not cuprophan, membrane fragments incubated in vitro with normal or uraemic plasma exhibited avid [125-I] beta 2M binding (respectively 12.9% vs 0.47% and 6.09% vs 0.06% of total beta 2M bound at 30 min, n = 6, P less than 0.001 for both). No in vitro generation of beta 2M from whole normal or uraemic blood could be demonstrated during incubation with either membrane.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Beta 2 microglobulin (beta 2M) amyloidosis is a dialysis complication. The AN69 membrane effectively removed beta 2M, unlike cuprophan, suggesting it may reduce amyloidosis risk in dialysis patients.
Area of Science:
- Nephrology
- Biomaterials Science
- Clinical Chemistry
Background:
- Beta 2 microglobulin (beta 2M) amyloidosis is a recognized complication of long-term dialysis.
- Accumulation of beta 2M is linked to dialysis membrane properties and patient status (oliguric vs. non-oliguric).
Purpose of the Study:
- To investigate the impact of different dialysis membranes (cuprophan and AN69) on plasma and ultrafiltrate beta 2M levels.
- To compare the in vivo and in vitro removal and binding characteristics of beta 2M with cuprophan and AN69 membranes.
Main Methods:
- Plasma and ultrafiltrate beta 2M concentrations were measured in 36 chronic hemodialysis patients.
- Acute dialysis studies and in vitro membrane-binding assays were performed using cuprophan and AN69 membranes.
Main Results:
- Long-term dialysis with AN69 in oliguric patients and cuprophan in non-oliguric patients resulted in lower plasma beta 2M than cuprophan in oliguric patients.
- AN69 membrane demonstrated significant in vivo removal of beta 2M (sieving coefficient 0.33) and avid in vitro binding, unlike cuprophan.
- Plasma beta 2M levels decreased during AN69 dialysis but increased slightly during cuprophan dialysis.
Conclusions:
- The AN69 membrane is more effective than cuprophan in removing beta 2M during hemodialysis.
- The findings suggest that AN69 membrane use may help mitigate the risk of beta 2M amyloidosis in dialysis patients.