Removal of free light chains in hemodialysis patients without multiple myeloma: a crossover comparison of three different dialyzers

Gabriele Donati, Maria Ilaria Moretti, Olga Baraldi, Alessandra Spazzoli, Irene Capelli, Giorgia Comai, Antonio Marchetti, Maria Sarma, Rita Mancini, Gaetano La Manna, Gabriele Donati, Maria Ilaria Moretti, Olga Baraldi, Alessandra Spazzoli, Irene Capelli, Giorgia Comai, Antonio Marchetti, Maria Sarma, Rita Mancini, Gaetano La Manna

Abstract

Background: Immunoglobulin light chains are classified as middle molecule uremic toxins able to interact with B lymphocyte membranes leading to the activation of transmembrane signaling. The ensuing impairment of neutrophil function can contribute to the chronic inflammation state of uremic patients, and the increased risk of bacterial infections or vascular calcifications. The aim of this crossover observational study was to assess the difference in free light chain removal by three different hemodialysis filters in patients not affected by multiple myeloma.

Methods: Free light chain removal was compared in the polymethylmethacrylate (PMMA) membrane Filtryzer BK-F, the polyphenylene HFR17 filter and the conventional polysulfone filter F7HPS. Twenty chronic hemodialysis patients were enrolled: mean age was 67.7 ± 17.0 years, M/F = 14/6, dialysis vintage (months) 25.5 ± 32.0. The patients were randomized into two groups of treatment lasting 6 weeks each. The dialysis sessions checked were the midweek sessions and the blood was drawn at times 0, 120' and 240'. Kappa (k) and lambda (λ) light chain levels, β2microglobulin (β2M), C reactive protein (CRP) and albumin were checked.

Results: K light chain levels were 345.0 ± 100.0 mg/L, λ light chains were 121.4 ± 27.0 mg/L. The values of k light chains at times 120' and 240' were significantly lower with PMMA and HFR17 than those obtained with F7. The reduction ratio per session (RRs) for k light chains was 44.1 ± 4.3% with HFR17, 55.3 ± 3.4% with PMMA, 25.7 ± 8.3% with F7 (p = 0.018). The RRs for λ light chains was 30.3 ± 2.9% with HFR17, 37.8 ± 17.3% with PMMA, 14.0 ± 3.9% with F7 (p = 0.032). As to β2M, RRs was 42.4 ± 3.2% with HFR17 vs. 33.9 ± 2.8% with PMMA vs. 6.3 ± 1.9% with F7 (p = 0.022). The three filters tested showed no differences in CRP or albumin levels.

Conclusion: In terms of light chain and β2M removal, the PMMA and on-line HFR filters are similar and both are significantly more effective than the F7 filter in chronic dialysis patients.

Trial registration: The present trial was registered retrospectively ( NCT02950389 , 31/10/2016).

Keywords: Free light chains; Hemodialysis; On-line HFR; PMMA; Removal; Toxins.

Figures

Fig. 1
Fig. 1
Study design
Fig. 2
Fig. 2
k free light chain removal with the three dialyzers tested at times 120’ PMMA = HFR17 

Fig. 3

λ free light chain removal…

Fig. 3

λ free light chain removal with the three dialyzers tested: no differences were…

Fig. 3
λ free light chain removal with the three dialyzers tested: no differences were found at the checking times considered

Fig. 4

β2M removal with the three…

Fig. 4

β2M removal with the three dialyzers tested at times 120’ PMMA = HFR17…

Fig. 4
β2M removal with the three dialyzers tested at times 120’ PMMA = HFR17 

Fig. 5

CRP values with the three…

Fig. 5

CRP values with the three dialyzers tested at the checking times considered

Fig. 5
CRP values with the three dialyzers tested at the checking times considered

Fig. 6

Comparison of the RRs obtained…

Fig. 6

Comparison of the RRs obtained with the three dialyzers tested for k and…

Fig. 6
Comparison of the RRs obtained with the three dialyzers tested for k and λ light chains and for β2M. PMMA = HFR17 > F7HPS

Fig. 7

Effect of dialysis with HFR17,…

Fig. 7

Effect of dialysis with HFR17, PMMA and F7 on k/λ ratio before dialysis…

Fig. 7
Effect of dialysis with HFR17, PMMA and F7 on k/λ ratio before dialysis (time 0’) and after dialysis (time 240’). Dashed lines = normal reference range. Continuous lines = extended renal failure reference range [9]
All figures (7)
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References
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Fig. 3
Fig. 3
λ free light chain removal with the three dialyzers tested: no differences were found at the checking times considered
Fig. 4
Fig. 4
β2M removal with the three dialyzers tested at times 120’ PMMA = HFR17 

Fig. 5

CRP values with the three…

Fig. 5

CRP values with the three dialyzers tested at the checking times considered

Fig. 5
CRP values with the three dialyzers tested at the checking times considered

Fig. 6

Comparison of the RRs obtained…

Fig. 6

Comparison of the RRs obtained with the three dialyzers tested for k and…

Fig. 6
Comparison of the RRs obtained with the three dialyzers tested for k and λ light chains and for β2M. PMMA = HFR17 > F7HPS

Fig. 7

Effect of dialysis with HFR17,…

Fig. 7

Effect of dialysis with HFR17, PMMA and F7 on k/λ ratio before dialysis…

Fig. 7
Effect of dialysis with HFR17, PMMA and F7 on k/λ ratio before dialysis (time 0’) and after dialysis (time 240’). Dashed lines = normal reference range. Continuous lines = extended renal failure reference range [9]
All figures (7)
Fig. 5
Fig. 5
CRP values with the three dialyzers tested at the checking times considered
Fig. 6
Fig. 6
Comparison of the RRs obtained with the three dialyzers tested for k and λ light chains and for β2M. PMMA = HFR17 > F7HPS
Fig. 7
Fig. 7
Effect of dialysis with HFR17, PMMA and F7 on k/λ ratio before dialysis (time 0’) and after dialysis (time 240’). Dashed lines = normal reference range. Continuous lines = extended renal failure reference range [9]

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