Clinical Experiences with On-Line Hemodiafiltration: A safe and Efficient Way to Increase beta2-microglobulin Removal

Kim, Hyun Chul

Abstract

A prospective study was done to evaluate the on- line hemodiafiltration(HDF) as a safe and efficient way to increase beta2-microglobulin(beta2-M) removal. We have compared treatment with hemodialysis(HD) and HDF in 10 stable patients over a period of three months. All HDF sessions were well tolerated. No pyrogenic reactions were observed during the study. Cardiovascular parameters were remarkably similar in both of treatment periods. However, the incidence of hypotension was significantly less frequent during HDF peroid(9.43% vs. 2.41%, P=0.04). The reduction rates of urea and creatinine were similar in both of treatment periods, ranging 60-70%. The beta2-M reduction rate was significantly improved by HDF compared to HD(43.2% vs. 6.8%, P=0.006). The serum beta2-M levels fell progressively from the HD value of 32.2mg/L to 21.0mg/L at the end of 3 months' HDF. In conclusion, HDF with on-line production of substitution fluid in has been confirmed by us to be a safe and more efficient way to increase beta2-M removal. Long-term clinical studies are necessary to determine whether improved removal of beta2-M will reduce or prevent the dialysis amyloidosis.