Nephrol Dial Transplant (2003) 18: 2596-2600
© 2003 European Renal Association-European Dialysis and Transplant Association
Original Article
Effect of dialyser membrane pore size on plasma homocysteine levels in haemodialysis patients
1Renal Unit and 2Department of Clinical Chemistry, AZ Sint-Jan AV, Brugge, Belgium
Correspondence and offprint requests to: An S. De Vriese, Renal Unit, AZ Sint-Jan AV, Ruddershove, 10, B-8000 Brugge, Belgium. Email: an.devriese{at}azbrugge.be
Background. Hyperhomocysteinaemia is a putative risk factor for atherothrombotic cardiovascular disease in the haemodialysis population. High-dose vitamin B therapy does not entirely normalize elevated plasma total homocysteine (tHcy) levels in haemodialysis patients. Alternative therapies to reduce tHcy further are therefore required. Modifications of the dialysis regimen may result in a better removal of Hcy. We examined the effect of dialyser membrane pore size on tHcy levels in vitamin-replete chronic haemodialysis patients.
Methods. Forty-five haemodialysis patients were dialysed during 4 weeks with a low-flux, a high-flux and a super-flux membrane, in random order. Pre-dialysis tHcy was determined at baseline and every 4 weeks. In 18 patients, plasma tHcy before and after dialysis and dialysate tHcy concentrations were measured.
Results. Pre-dialysis tHcy decreased significantly during 4 weeks super-flux dialysis (-14.6 ± 2.8%), whereas it remained stable during high-flux (+0.5 ± 2.4%) and low-flux dialysis (+1.7 ± 3.2%). The homocysteine reduction ratio was not different for the three membranes: 0.39 ± 0.03 for the super-flux, 0.47 ± 0.02 for the high-flux and 0.39 ± 0.02 for the low-flux dialyser. The amount of Hcy recovered in the dialysate during a single dialysis session was also similar: 117.5 ± 3.6 µmol during super-flux, 95.3 ± 11.5 µmol during high-flux and 116.5 ± 11.6 µmol during low-flux dialysis.
Conclusion. Super-flux dialysis significantly lowers tHcy in chronic haemodialysis patients. Improved removal of middle-molecule uraemic toxins with inhibitory effects on Hcy-metabolizing enzymes, rather than better dialytic clearance of Hcy itself, may explain the beneficial effect of the super-flux membrane.
Keywords: dialyser membrane; haemodialysis; high-flux; low-flux; super-flux; total homocysteine (tHcy)
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