High-flux hemodialysis postpones clinical manifestation of dialysis-related amyloidosis

Amyloidosis due to the retention of beta(2)-microglobulin (beta(2)-MG) is a frequent complication of hemodialysis (HD). Significant amounts of beta(2)-MG can be removed from the body by highly permeable HD membranes, whereas conventional low-flux membranes are impermeable for the molecule. In a prospective and controlled study we investigated whether high-flux HD could delay the onset of dialysis-related amyloidosis (DRA). Twenty patients treated with cuprophane low-flux HD membranes were matched for age and previous time on HD either to continue their HD regimen or to receive HD treatment with high-flux polysulfone membranes. For 6 years each patient was examined for manifestations of DRA once a year or upon individual needs, additionally, serum beta(2)-MG levels were monitored. After 6 years of follow-up no clinical signs of DRA were found in any of the patients dialyzed with high-flux polysulfone membranes, whereas 8/10 of the conventionally dialyzed patients had CTS and/or osteoarticular lesions. Serum levels of beta(2)-MG were significantly reduced in patients treated with high-flux polysulfone membranes.