Direct Hemoperfusion with Polymethylmethacrylate for Hemodialysis Patients with Dialysis-Related Amyloidosis.

IF 1.8 3区医学 Q3 HEMATOLOGY

Blood Purification Pub Date : 2025-08-05 DOI:10.1159/000546771

Shoko Yamazaki, Daisuke Miyauchi, Atsushi Hashimoto, Takahiro Tanaka, Mototsugu Tanaka, Hisaki Shimada, Yuji Ishii, Koji Matsuo, Akio Kasai, Yutaka Koda, Kokichi Saito, Junichi Hoshino, Shinichi Nishi, Suguru Yamamoto

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引用次数: 0

Abstract

Introduction: Dialysis-related amyloidosis (DRA) is a serious complication in patients undergoing long-term dialysis that leads to conditions such as carpal tunnel syndrome and destructive spondyloarthropathy. Improved removal of the precursor protein β₂-microglobulin (β₂-m) is considered an effective treatment strategy for DRA. Polymethylmethacrylate (PMMA) membranes have the capacity to adsorb β₂-m in dialysis filters, suggesting that direct hemoperfusion with PMMA in addition to standard dialysis may enhance β₂-m removal.

Methods: This prospective cohort study included 10 patients undergoing hemodialysis, who were diagnosed with DRA. The participants were treated with dialysis filter alone during visit 1, both standard dialysis filter and PMMA cartridges (FT-75, volume 75 cm3) during visits 2-4, and FT-145 PMMA cartridges (volume 145 cm3) during visits 5-7. The removal rates and clearances of β₂-m were quantified. We also assessed the removal of α₁-microglobulin (α₁-m), matrix metalloproteinase-3 (MMP-3), interleukin-6 (IL-6), and tumor necrosis factor-a (TNF-α), which may be associated with DRA symptoms.

Results: PMMA cartridge had increased β₂-m removal rates compared to dialysis filter alone for treatment duration of 240 min. Similarly, the removal rates of α₁-m and MMP-3 were higher with PMMA cartridges than with dialysis filter alone. β₂-m, α₁-m, and MMP-3 clearance improved with the addition of PMMA cartridges, depending on the cartridge size. The removal rates of IL-6 and TNF-α were higher with PMMA cartridges than with dialysis filter alone at 30 min, but not at 240 min.

Conclusion: Direct hemoperfusion with PMMA is an effective method for removing β₂-m in hemodialysis patients with DRA. Beneficial effects were also observed for the removal of α₁-m and MMP-3. Further research is required to evaluate the long-term efficacy of this approach in managing DRA.

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聚甲基丙烯酸甲酯直接血液灌流治疗透析相关性淀粉样变性患者。

透析相关淀粉样变性（DRA）是长期透析患者的严重并发症，可导致腕管综合征和破坏性脊椎关节病等疾病。改善前体蛋白β2-微球蛋白（β2-m）的去除被认为是DRA的有效治疗策略。聚甲基丙烯酸甲酯（PMMA）膜具有吸附透析过滤器中β2-m的能力，这表明在标准透析之外，PMMA直接血液灌注可能会增强β2-m的去除。方法本前瞻性队列研究纳入10例诊断为DRA的血液透析患者。参与者在第1次就诊期间单独使用透析过滤器，在第2-4次就诊期间使用标准透析过滤器和PMMA滤芯（FT-75，体积75 cm³），在第5-7次就诊期间使用FT-145 PMMA滤芯（体积145 cm³）。定量测定了β2-m的去除率和清除率。我们还评估了可能与DRA症状相关的α1-微球蛋白（α1-m）、基质金属蛋白酶-3 （MMP-3）、白细胞介素-6 （IL-6）和肿瘤坏死因子-a （TNF-α）的去除情况。结果在240 min的处理时间内，PMMA滤芯对β2-m的去除率高于单独透析滤芯。同样，PMMA滤芯对α1-m和MMP-3的去除率高于单独透析滤芯。β2-m、α1-m和MMP-3的间隙随着PMMA滤芯的加入而提高，具体取决于滤芯的大小。在30 min时，PMMA滤芯对IL-6和TNF-α的去除率高于单独使用透析滤芯，但在240 min时则没有。结论PMMA直接血液灌流是清除DRA血液透析患者β2-m的有效方法。对α1-m和MMP-3的去除也有有益的效果。需要进一步的研究来评估这种方法在治疗DRA方面的长期疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.