Fry Andrew C, Singh Dhruv K, Chandna Shahid M, Farrington Ken
Renal Unit, Lister Hospital, Stevenage, UK.
Blood Purif. 2007;25(3):295-302. doi: 10.1159/000104870. Epub 2007 Jul 2.
Convective blood purification improves beta(2)-microglobulin (beta(2)M) removal and may delay the onset of dialysis-related amyloidosis. We assessed the differential effects of high-flux haemodialysis (HD) and on-line haemodiafiltration (HDF) on plasma beta(2)M levels, given the enhanced convective capability of HDF.
We measured pre-dialysis beta(2)M levels in 297 patients in a programme employing both high-flux HD and HDF, then analysed the relationship of beta(2)M to modality and other variables.
Independent determinants of plasma beta(2)M levels were residual renal function, age, HD vintage, and C-reactive protein load, but not the patient's predominant modality (high-flux HD or HDF). Patients with KRU levels <0.5 ml/min had significantly higher beta(2)M levels than patients with KRU between 0.5 and 1 ml/min.
Residual renal function is of overriding importance as a determinant of beta(2)M levels in HD patients and may supersede enhanced convective clearance by HDF. Beneficial effects extend to very low levels of residual renal function.
对流血液净化可改善β2-微球蛋白（β2M）清除，并可能延迟透析相关淀粉样变的发生。鉴于血液透析滤过（HDF）增强的对流能力，我们评估了高通量血液透析（HD）和在线血液透析滤过（HDF）对血浆β2M水平的不同影响。
我们在一个同时采用高通量HD和HDF的项目中测量了297例患者透析前的β2M水平，然后分析了β2M与透析方式及其他变量之间的关系。
血浆β2M水平的独立决定因素是残余肾功能、年龄、HD治疗时间和C反应蛋白负荷，而不是患者的主要透析方式（高通量HD或HDF）。残余肾功能（KRU）水平<0.5 ml/min的患者的β2M水平显著高于KRU在0.5至1 ml/min之间的患者。
残余肾功能作为HD患者β2M水平的决定因素至关重要，可能会取代HDF增强的对流清除作用。有益作用甚至在残余肾功能非常低的水平时也存在。
