Effect of protein leaking BK-F PMMA-based hemodialysis on plasma pentosidine levels

J Nephrol. Sep-Oct 2004;17(5):707-14.

Abstract

Background: Advanced glycation end-products (AGEs) are now considered to contribute to the middle molecule toxicity of uremia and, because they are not cleared by conventional low-flux hemodialysis, alternative strategies are needed to improve their removal.

Methods: In a prospective cross-over trial involving 18 adult chronic hemodialysis subjects, we evaluated the intradialytic removal and the long-term effect on predialysis levels of Protein-bound (PBPe) and Free (FPe) pentosidine by high-pore, protein-leaking BK-F Polymethylmethacrylate-based hemodialysis (BK-F-HD), by comparing it to hemodialysis using low-flux dialyzers (LF-HD).

Results: A single BK-F-HD session removed more PBPe, but not FPe, than LF-HD. Long-term BK-F-HD was associated with a significant decrease in pre-dialysis PBPe, FPe, and albumin (17.7 +/- 20.8, 25.3 +/- 17.3 and 8.0 +/- 3.3%, p<0.01) and no change in body mass index and protein catabolic rate, compared to LF-HD. Multiple stepwise regression analysis identified C-reactive Protein (CRP) (standardized beta coefficient=-0.629), pre-dialysis levels in LF-HD (beta=0.452) and dialysis vintage (beta=0.428) as significant determinants of BK-F-induced changes in predialysis PBPe, and predialysis FPe and PBPe levels in LF-HD as significant determinants of BK-F-induced changes in predialysis FPe (beta=0.720 and 0.286, respectively).

Conclusions: Our study shows that long-term standard diffusive hemodialysis with BK-F membrane reduces predialysis PBPe and FPe levels by comparison with LF-HD, largely due to a greater intradialytic clearance of PBPe. Serum albumin is also reduced without any associated changes in nutritional status markers. The study also suggests that the effect of BK-F-HD in lowering PBPe levels is modulated by the body burden of pentosidine and is blunted or even lost in the presence of elevated CRP levels.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial

MeSH terms

  • Aged
  • Arginine / analogs & derivatives*
  • Arginine / blood*
  • Blood Proteins / metabolism
  • Cross-Over Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Kidney Failure, Chronic / blood*
  • Kidney Failure, Chronic / therapy*
  • Lysine / analogs & derivatives*
  • Lysine / blood*
  • Male
  • Membranes, Artificial*
  • Middle Aged
  • Polymethyl Methacrylate*
  • Prospective Studies
  • Protein Binding
  • Renal Dialysis / instrumentation*
  • Time Factors
  • Treatment Outcome

Substances

  • Blood Proteins
  • Membranes, Artificial
  • Polymethyl Methacrylate
  • Arginine
  • pentosidine
  • Lysine