The elevation of plasma levels of myeloperoxidase and polymorphonuclear leukocyte elastase as an index of bioincompatibility of the column during hemodialysis using with a β₂-microglobulin-selective adsorbent column

Abstract

Background. It is well known that dialysis-related amyloidosis (DRA) is a serious major complication in long-term hemodialysis (HD) patients, and β₂-microglobulin (MG) accumulation is recognized to be the major cause of DRA. Recently, a β₂-MG selective adsorbent column has been developed for eliminating β₂-MG from the circulating blood.

We developed a novel enzyme immunoassay (EIA) method to measure myeloperoxidase (MPO), and observed the course of plasma MPO and polymorphonuclear leukocyte (PMN)-elastase concentrations as an index of the bioincompatibility of this column during treatment.

Methods. Six patients undergoing maintenance HD participated in this study. Both proteins (MPO and PMN-elastase) were compared in patients receiving HD without this column and HD with this column. The concentrations were measured by EIA. The MPO assay was established in our laboratory, using our monoclonal anti-MPO antibody.

Results. Both proteins were markedly elevated during HD with this column, compared with their concentrations in patients receiving HD without this column.

Conclusion. Marked elevation of both MPO and PMN-elastase, indicating excessive granulocyte activation, was caused by the use of this column. It is possible that this phenomenon may lead to serious pathogenic conditions and progress to DRA in HD patients with long-term use of this column. At present, we have no data for long-term use. In future, the advantages and disadvantages of long-term use of this column should be investigated.