Application of Cystatin C Reduction Ratio to High-Flux Hemodialysis as an Alternative Indicator of the Clearance of Middle Molecules.
10.3904/kjim.2010.25.1.77
- Author:
Joon Sung PARK
1
;
Gheun Ho KIM
;
Chong Myung KANG
;
Chang Hwa LEE
Author Information
1. Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea. changhwa@hanyang.ac.kr
- Publication Type:Original Article ; Clinical Trial
- Keywords:
Dialysis;
beta 2-Microglobulin;
Cystatin C
- MeSH:
Adult;
Aged;
Biological Markers/blood;
Case-Control Studies;
Cystatin C/*blood;
Female;
Hemodialysis Solutions;
Humans;
Kidney Failure, Chronic/*blood/*therapy;
Male;
Middle Aged;
Models, Biological;
Nephelometry and Turbidimetry/*methods;
Renal Dialysis/*methods;
Urea/blood;
Uremia/blood/therapy;
beta 2-Microglobulin/blood
- From:The Korean Journal of Internal Medicine
2010;25(1):77-81
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: Although high-flux (HF) dialyzers with enhanced membrane permeability are widely used in current hemodialysis (HD) practice, urea kinetic modeling is still being applied to indicate the adequacy of both low-flux (LF) and HF HD. In comparison with urea (molecular weight, 60 Da) and beta2-microglobulin (beta2MG, 12 kDa), cystatin C (CyC, 13 kDa) is a larger molecule that has attractive features as a marker for assessing solute clearance. We postulated that CyC might be an alternative for indicating the clearance of middle molecules (MMs), especially with HF HD. METHODS: Eighty-nine patients were divided into LF and HF groups. Using single pool urea kinetic modeling, the urea reduction ratio (URR) and equilibrated Kt/Vurea (eKt/Vurea) were calculated. The serum CyC concentrations were measured using particle-enhanced immunonephelometry. As indices of the middle molecular clearance, the reduction ratios of beta2MG and CyC were calculated. RESULTS: The beta2MG reduction ratio (beta2MGRR) and CyC reduction ratio (CyCRR) were higher in the HF group compared to the LF group. However, the URR and eKt/Vurea did not differ between the two groups. The CyCRR was significantly correlated with the eKt/Vurea and beta2MGRR (r = 0.47 and 0.69, respectively, both p < 0.0001). CONCLUSIONS: Compared to the LF dialyzer, the HF dialyzer removed CyC and beta2MG more efficiently. Unlike the beta2MGRR, the CyCRR was correlated with the eKt/Vurea and beta2MGRR. This study suggests a role for the CyCRR as an alternative indicator of the removal of MMs.
