Beta-2-microglobulin kinetics during paired filtration dialysis

Although the accumulation of beta-2-microglobulin (beta2M) occurs in end-stage renal disease (ESRD) patients prior to the initiation of dialysis, there is increasing evidence that the mode of dialysis treatment plays an important role in the development of amyloidosis. In the present study, a hemofiltration technique that uses both convection and diffusion, with a double chamber hemodialyzer composed of high-flux polysulphone and hemophan (paired filtration dialysis--PFD) was evaluated with regard to the beta2M removal capacity during PFD in 8 stable ESRD patients. PFD resulted in a significant (P < 0.001) beta2M removal during a 210-min dialysis session. The sieving coefficient was calculated to be 0.6 +/- 0.07 at 60 min after the start of PFD. The mean beta2M concentration in the ultrafiltrate was 13.4 +/- 1.6 mg/L, and total quantity cleared by convection alone was 135.9 +/- 12.6 mg/session. These data demonstrate that PFD is a highly efficient, variable convection-diffusion rate mixed depuration technique, that can remove beta2M with a minimal back-filtration risk and without the need of great amounts of special reinfusion solutes.