Hemodiafiltration improves free light chain removal and normalizes κ/λ ratio in hemodialysis patients

Chloé Bourguignon, Leïla Chenine, Anne Sophie Bargnoux, Hélène Leray-Moragues, Bernard Canaud, Jean-Paul Cristol, Marion Morena, Chloé Bourguignon, Leïla Chenine, Anne Sophie Bargnoux, Hélène Leray-Moragues, Bernard Canaud, Jean-Paul Cristol, Marion Morena

Abstract

Background/aims: Serum free light chain (FLC) levels are correlated with chronic kidney disease (CKD) stages and are highest in patients on hemodialysis (HD). Aim of this study was to assess the FLC removal efficiency of Elisio™-210H dialyzer using either high-flux HD or on line high efficiency hemodiafiltration (HDF) modalities in CKD-5D patients.

Methods: In this prospective and comparative study, 20 CKD-5D patients free from multiple myeloma were randomized in two groups: HD versus on line HDF. All patients were dialyzed with Elisio™-210H dialyzer. Serum samples were collected before and after the midweek dialysis session, before randomization and at the end of the study to measure κ and λ FLC concentrations. Reduction ratios were corrected for net ultrafiltration.

Results: For both HD and HDF mode, κ and λ FLC concentrations were significantly lower after dialysis than before but median reductions in κ and λ FLC levels were significantly higher in HDF versus HD groups (κ 73.5 vs. 65.5 %, p = 0.04 and λ 51.0 vs. 36.6 %, p = 0.07). After dialysis, all κ/λ ratio values were between 0.26 and 1.65 which is the reference range described in subjects with normal kidney function, for both HD and HDF groups (median κ/λ ratios were 0.80 [0.47-1.22] and 0.67 [0.50-0.79] respectively).

Conclusion: This study shows the superiority of on line HDF compared with HD to remove both κ and λ FLC. Moreover, all post-dialysis κ/λ ratios reached normal reference range.

Keywords: CKD; HDF; Internal convection HD; Serum free light chain removal.

References

    1. Clin Chem. 2002 Sep;48(9):1437-44
    1. J Nephrol. 2015 Apr;28(2):251-4
    1. J Am Soc Nephrol. 2007 Mar;18(3):886-95
    1. Mayo Clin Proc. 2014 May;89(5):615-22
    1. Biomater Artif Cells Immobilization Biotechnol. 1991;19(1):97-109
    1. J Am Soc Nephrol. 2005 Aug;16(8):2421-30
    1. BMC Nephrol. 2008 Sep 22;9:11
    1. ASAIO J. 1997 Nov-Dec;43(6):904-9
    1. Blood Purif. 2014;37(2):93-8
    1. Nephrol Dial Transplant. 2002 May;17(5):879-83
    1. Clin Chem. 2001 Apr;47(4):673-80
    1. Nephrol Dial Transplant. 2011 Nov;26(11):3627-33
    1. Clin J Am Soc Nephrol. 2008 Nov;3(6):1684-90
    1. Toxins (Basel). 2013 Nov 08;5(11):2058-73
    1. Clin J Am Soc Nephrol. 2011 Dec;6(12):2829-37
    1. Lancet. 1987 Mar 14;1(8533):628-9

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere