High-Flux dialyzer 2.6 m2 is promising for free light chains removal in high-flux hemodialysis and in hemodiafiltration

Abstract

Immunoglobulin light chains are classified as middle molecule uremic toxins and its removal through effective dialyzer is needed with less albumin loss. This study assessed the free light chains (FLC) removal using dialyzer surface area (SA) 2.6m2 in high-flux dialysis (HF-HD) versus hemodiafiltration (HDF) and its relation to cumulative dialysate albumin loss. This pilot cross-over study included 25 patients who underwent hemodialysis (HD) using dialyzer surface area 2.6m2 on HF-HD followed by online post-dilution HDF with washout period of 2 weeks using high-flux dialyzers (max 2.0 m2 SA). All patients were subjected to single session measurement of dialysate albumin every hour and pre/post dialysis levels of FLC Kappa (Κ) and Lambda (λ) by ELISA. Dialyzer (SA) 2.6m2 showed a significant reduction in post-dialysis kappa and lambda level in comparison to pre-dialysis level on HF-HD and hemodiafiltration (P<0.001). HDF showed higher kappa and lambda FLC reduction ratio (45.16 ± 6.53 %, 28.68 ± 4.36 %, respectively compared to HF-HD (29.52 ± 6.38 %, 19.48 ± 1.96, respectively, P<0.001 for both). Patients on HDF dialysis had significant total albumin loss in dialysate [median (IQR) 2.97; 1.98 - 3.37 gm] compared to HF-HD [median (IQR) 0.67; 0.49 - 1.13 gm] (P <0.001). In conclusion, high-flux dialyzer 2.6 m2 (SA) may be effective in free light chains removal especially with online post-dilution hemodiafiltration with acceptable albumin loss.