الفهرس 
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Abstract
Introduction:
Uremic toxins are solutes that accumulate in human body in kidney impairment and cause harmful biological effects. They are classified according to molecular weight into; small-water soluble, medium sized and protein bound solutes. Recently, middle-sized molecules have been associated with chronic inflammatory conditions, dialysis related complications and cardiovascular complications.
Free light chains are classified as middle-sized molecules, (Kappa: 25KDa, Lambda 45KDa), their level increase markedly in CKD and ESRD patients. They are associated with neutrophils dysfunction, vascular calcification, and chronic inflammatory state.
Most hemodialysis techniques have the capacity of removal of small water-soluble molecules but have difficulties in removal of FLCs. Convective techniques and high permeable dialyzers remove FLCs efficiently but with significant transmembrane albumin loss.
Aim of the study:
In this study we aimed to assess free light chains removal using high-flux dialyzer SA 2.6 m2 on high-flux dialysis versus hemodiafiltration and its relation to albumin loss.
Patients and methods:
Our study was done in Ain Shams University hemodialysis units, where 25 ESRD patients were recruited. Free light chains (kappa and Lambda) removal, albumin loss and CRP were assessed in all patients by 2 different hemodialysis modalities (HF-HD and HDF) with wash out period 2 weeks in between them using high flux dialyzers (max 2.0 m2 surface area).
Prevalent HD patients aged 18-60 years, undergoing regular HD 3 sessions/ week for at least 4 hours for > 6 months using bicarbonate dialysate and unfractionated heparin as anticoagulation, blood flow (QB) ≥300ml/min were included. Patients with temporary dialysis catheters, active inflammation and/or infections, decompensated heart failure, liver cell failure Child B, C and with known malignancies were excluded.
All patients were subjected to:
Full history taking and clinical examination. Laboratory investigations were done including “Complete blood count, routine chemistry (S. creatinine, BUN, S. Sodium and S. potassium, AST, ALT, Corrected s. calcium, phosphate), Parathyroid hormone (PTH)”.
FLCs level (kappa and lambda), hsCRP was measured before and after a single session on each modality. Albumin was collected on half,1st,2nd,3rd and 4th hour of HD session to calculate cumulative albumin loss.
Summary of Results:
Our results showed statistically significant RR of FLCs (Kappa and Lambda) on both HF-HD and HDF sessions. With higher reduction on HDF session reaching average (Kappa: 29%, Lambda 19%) (Kappa: 47%, Lambda 29%), respectively with P<0.001. While there was no statistically significant reduction as regard hsCRP on both modalities P=0.361.
As regard albumin loss, it was higher on HDF session, when compared to HF-HD, median 2.97 (1.98-3.37) gm to median 0.67 (0.49-1.13) gm respectively with P<0.001.
Maximum Dialysate albumin loss on HDF was on the first hour with median 1.43(0.92-1.52) gm.
Total albumin loss was positively correlated with mean TMP with P<0.001 for HDF and p=0.025 for HF-HD.
Conclusion:
High-flux BIOPURE 260H 2.6 m2 dialyzer is effective for middle-molecules removal especially with online post-dilution hemodiafiltration with acceptable albumin loss.