REMARKABLE REMOVAL OF BETA-2-MICROGLOBULIN BY ONLINE HEMODIAFILTRATION

Eight chronic, anuric hemodialysis patients were randomly treated with a high-flux polysulphone dialyzer (F80), using 6 different modes: con ventional bicarbonate hemodialysis (HD), hemodiafiltration (HDF) with a replacement solution at 40, 60, 80 or 100 ml/min in postdilution and 80 ml/min in predilution. The differences in beta(2)-microglobulin (b eta 2M) reduction ratio and clearance were evaluated statistically by analysis of variance (ANOVA). Both studies revealed no significant dif ference between HD and HDF40 in postdilution, but an increasing signif icant difference from HDF60 to HDF100 in postdilution and with HDF80 i n predilution. The mean reduction ratio ranged from 49.7 (HD) to 72.7% (HDF 100 ml/min), showing an overall statistically significant differ ence (p = 0.0000). For the clearance, the range was between 63.8 (HD) and 116.8 ml/min (HDF 100 ml/min) (p = 0.0000). beta 2M in the effluen t dialysate with HDF100 ml/min reached up to a mean of 258 mg/session. Concerning small molecules (BUN, creatinine and P), there was a stati stically significant different clearance for creatinine and especially for P with HDF 100 ml/min. Conclusion: HDF with an on-line replacemen t solution at 100 ml/min and a high-flux and biocompatible polysulphon e membrane represents a new tool for enhanced removal of beta 2M. Besi des a significant increase in creatinine and especially in phosphorus clearance is noted.