The limit to which serum β₂-MG level could be lowered by an intermittent hemopurification approach

Abstract

We developed a too-pool kinetic model for β₂-MG consisting of interstitial and plasma space and simulated the serum β₂-MG concentration trends in patients with end-stage renal failure on hemodialysis for a long period of time. In this model, we supposed that 1) the generation rate would not change even if the β₂-MG concentration fluctuated and 2) β₂-MG degradation rate within the body between treatments was culculated as the product of the β₂-MG concentration and time independent intrinsic clearance and further, 3) during an intermittent treatment β₂-MG degradation rate was culculated as the product of the β₂-MG concentration and the artificial kidney clearance plus 2). The results showed that a dramatic fall of serum β₂-MG level could be expected right after treatment, however, a gradual rise of serum concentrations, which we call a rebound phenomenon, is observed between treatments. Asuming that a dialyzer clearance for β₂-MG is 50ml/min and 4 hour dialysis is performed 3 times a week, estimated pre-dialysis serum levels of β₂-MG after 2 weeks in patients with initial serum levels of 60, 40, and 20ml/l are 39.2, 30.8 and 18.4 mg/l, respectively, due mainly to the above mentioned rebound phenomenon. This means that a continuous fall of the serum concentration could not be obtained by a present method of intermittent hemopurification especially in patients with relatively lower serum β₂-MG level among HD patients.