Hemodiafiltration improves free light chain removal and normalizes κ/λ ratio in hemodialysis patients
Serum free light chain (FLC) levels are correlated with chronic kidney disease (CKD) stages and are highest in patients on hemodialysis (HD). Aim of this study was to assess the FLC removal efficiency of Elisio™-210H dialyzer using either high-flux HD or on line high efficiency hemodiafiltration (HDF) modalities in CKD-5D patients.
In this prospective and comparative study, 20 CKD-5D patients free from multiple myeloma were randomized in two groups: HD versus on line HDF. All patients were dialyzed with Elisio™-210H dialyzer. Serum samples were collected before and after the midweek dialysis session, before randomization and at the end of the study to measure κ and λ FLC concentrations. Reduction ratios were corrected for net ultrafiltration.
For both HD and HDF mode, κ and λ FLC concentrations were significantly lower after dialysis than before but median reductions in κ and λ FLC levels were significantly higher in HDF versus HD groups (κ 73.5 vs. 65.5 %, p = 0.04 and λ 51.0 vs. 36.6 %, p = 0.07). After dialysis, all κ/λ ratio values were between 0.26 and 1.65 which is the reference range described in subjects with normal kidney function, for both HD and HDF groups (median κ/λ ratios were 0.80 [0.47–1.22] and 0.67 [0.50–0.79] respectively).
This study shows the superiority of on line HDF compared with HD to remove both κ and λ FLC. Moreover, all post-dialysis κ/λ ratios reached normal reference range.
KeywordsCKD HDF Internal convection HD Serum free light chain removal
FREELITE immunoassay kits were provided with the compliments of The Binding Site (Birmingham, UK). This study was supported by Nipro Corporation, Japan.
Conflict of interest
Chloé Bourguignon, Leïla Chenine, Anne Sophie Bargnoux, Hélène Leray-Moragues, Jean-Paul Cristol and Marion Morena have no conflicts of interest to declare. Bernard Canaud is a full-time employee of Fresenius Medical Care. The research conducted was sponsored by Nipro Corporation.
The study was conducted in accordance with the principles of the Declaration of Helsinki and in compliance with the International Conference on Harmonization/Good Clinical Practice regulations. In accordance with French Law, the study was approved by our Institution’s ethical committee with the following number 2008-A00852-53. The study was also registered at clinicaltrials.gov (NCT01653808).
Informed consent was obtained from all individual participants included in the study.
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