Relative Importance of Residual Renal Function and Convection in Determining Beta-2-Microglobulin Levels in High-Flux Haemodialysis and On-Line Haemodiafiltration

Several studies have shown that patients who have been dialyzed with high-flux biocompatible membranes have a lower plasma level of beta 2-microglobulin and a lower incidence of amyloid disease compared with patients who have been dialyzed with low-flux bioincompatible membranes. However, because high-flux membranes are associated with significant dialytic removal of beta 2-microglobulin, the specific role of membrane biocompatibility in influencing the rate of increase of beta 2-microglobulin has not been previously determined. This study investigated the effect of biocompatibility on the rate of increase of plasma levels of beta 2-microglobulin in 159 new hemodialysis patients from 13 dialysis centers (ten centers affiliated with Dallas Nephrology Associates and three with Vanderbilt University Medical Center) by using two low-flux membranes with widely different biocompatibilities. These patients were prospectively randomized to be dialyzed with either a low-flux biocompatible membrane or a low-flux bioincompatible membrane. Plasma beta 2-microglobulin levels were measured at 0, 3, 6, 9, 12, and 18 months. Sixty-six patients completed the 18-month study. Plasma beta 2-microglobulin increased in all patients; however, the increase was not significantly different from baseline at any time point in the group that used the biocompatible membrane. In this group, beta 2-microglobulin increased from (mean +/- SD) 27.8 +/- 14.8 mg/L to 34.0 +/- 10.0 mg/L at 18 months (P = not significant), and the mean increase at 18 months was 2.6 +/- 14.7 mg/L. In contrast, the increase in plasma beta 2-microglobulin level in the bioincompatible membrane group became significant in Month 6 when the levels had increased from a baseline of 24.8 +/- 9.6 mg/L to 29.5 +/- 12.2 mg/L (P < 0.001); these increases continued to be significant until Month 18, when serum beta 2-microglobulin reached 36.8 +/- 13.9 mg/L with an average increase of 11.8 +/- 11.2 mg/L (P < 0.0001). The higher rate of plasma B2-microglobulin increase in the group that had been dialyzed with the bioincompatible membrane was also evident when only patients who had completed the study were analyzed. There were no significant differences in the actual level of beta 2-microglobulin or in residual renal function between the two groups during the 18 months of the study. It was concluded that over a period of 18 months, the use of biocompatible membranes, even in the low-flux configuration, is associated with a significantly slower increase in plasma beta 2-microglobulin, independent of the influence of residual renal function.

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Serum Beta-2-Microglobulin Level and Residual Renal Function in Peritoneal Dialysis

Nephron ◽

10.1159/000187533 ◽

1993 ◽

Vol 65 (3) ◽

pp. 469-471 ◽

Cited By ~ 32

Author(s):

Gianpaolo Amici ◽

Giovambattista Virga ◽

Giorgio Da Rin ◽

Stefano Grandesso ◽

Alberto Vianello ◽

...

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Residual Renal Function ◽

Beta 2 ◽

Beta 2 Microglobulin

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MP547CYSTATIN C AND BETA-2 MICROGLOBULIN - VALUABLE BIOMARKERS OF RESIDUAL RENAL FUNCTION IN PERITONEAL DIALYSIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfx176.mp547 ◽

2017 ◽

Vol 32 (suppl_3) ◽

pp. iii629-iii630

Author(s):

Carla Moreira ◽

Liliana Cunha ◽

Maria Carvalho ◽

José Oliveira ◽

Olívia Santos ◽

...

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Residual Renal Function ◽

Beta 2 ◽

Beta 2 Microglobulin

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Incremental Hemodialysis Schedule in Patients with Higher Residual Renal Function at the Start of Dialysis

Advances in Nephrology ◽

10.1155/2014/236245 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Milagros Fernández Lucas ◽

José Luis Teruel ◽

Gloria Ruíz-Roso ◽

Martha Díaz ◽

Viviana Raoch ◽

...

Keyword(s):

Renal Function ◽

Cost Effective ◽

Clinical Situation ◽

Residual Renal Function ◽

Additional Benefit ◽

Weekly Schedule ◽

Decline Rate ◽

Incremental Hemodialysis ◽

Beta 2 ◽

Beta 2 Microglobulin

We present an observational study to evaluate a progressive schedule of dose of dialysis, starting with 2 HD/week, when the renal clearance of urea was equal to or greater than 2,5 mL/min/1,73 m2 and the patient is in a stable clinical situation. From 2006 to 2011, 182 patients started hemodialysis in our center, of which 134 were included in the study. Residual renal function (RRF), Kt/V, eKru, nPCR, hemoglobin, weekly erythropoietin dose, and beta-2-microglobulin were determined at 6, 12, 18, 24, and 30 months after dialysis initiation. Seventy patients (52%) began with the progressive schedule of 2 HD/week and 64 (48%) patients began with the conventional thrice-weekly schedule (3 HD/week). The decline of RRF was lower in the group of 2 HD/week: 0,20 (0,02–0,53) versus 0,50 (0,14–1,08) mL/min/month (median and interquartile range, P=0,009). No relationship was found between the decline rate and the basal RRF. Survival analysis did not show differences between both groups. Our experience demonstrates that patients with higher residual renal function may require less than conventional 3 HD sessions per week at the start of dialysis. Twice-weekly hemodialysis schedule is safe and cost-effective and may have additional benefit in maintaining the residual renal function.

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