Effect of hemodialysis membranes on beta(2)-microglobulin amyloidosis

Early after the identification of beta (2)-microglobulin amyloidosis (A bet a M-2) as the cause of carpal tunnel syndrome, it was thought that hemodial ysis was a major cause in the development of the disease. It was subsequent ly shown that hemodialysis was not necessary for the development of dialysi s-related amyloidosis; however, it was believed that the different dialysis membranes did modulate the progression of the disease. Current data demons trate that hemodialysis fails to prevent or reverse the disease, but there is substantial evidence that high-flux, high-efficiency dialyzers slow its progression. Many factors related to hemodialysis have been evaluated in re lation to A beta M-2, including the effect of the bioincompatibility of the membrane, the capacity of the different membranes to remove beta M-2, and the effect of reuse on beta M-2 levels. Moreover, there have been intensive efforts to evaluate, explore, and improve the different mechanisms in beta M-2 removal, with adsorption as a promising prospect. With the available e vidence, it seems that the removal of beta M-2 by the membrane plays the mo st important role in modulating the disease outcome and rate of progression , although a large, long-term, multicentered and randomized study is still lacking to prove this relationship. However, it is possible that with the c ontinuing advances in optimizing the beta M-2 removal efficiency of the dif ferent membranes, the frequency and severity of the disease can be substant ially decreased.