Abstract
Dialysis-related amyloidosis (DRA) is characterized by the presence of an amyloid protein, β2-microglobulin (β2-MG), in the plasma of patients. In order to eliminate β2-MG from the circulating blood of DRA patients, a β2-MG selective adsorbent for direct haemoperfusion (DHP) has been developed. The adsorbent is porous cellulose beads to which the hydrophobic organic compound is covalently bound, and adsorbs more than 1mg of β2-MG per ml of beads in vitro. A DHP column (BM-01), containing 350ml of the adsorbent, was subjected to clinical trials. The column was connected with a dialyzer (PAN or PMMA membrane) in series. The BM-01 column was used 3 times a week for 1 week (11 patients), 4 weeks (9 patients), 6 months (1 patient) and 12 months (2 patients). All patients had undergone chronic haemodialysis for periods of more than 10 years. The reduction rates in the β2-MG level (RR) for 20 patients treated for 1 or 4 weeks were more than 64%. For 3 patients treated for more than 6 months, RR were 76.5±4.9, 73.5±5.7 and 72.2±6.2%. At the end of each session, the plasma concentration of β2-MG was controlled below 10mg/l and 3.4mg/l was the minimum. The total amounts of removed β2-MG (mg/session) were 172.5±22.3, 257.0±75.6, 157.6±32.2 and 429.8mg/session at maximum. Two out of these three patients showed a favorable effect on joint symptoms and in the ocular fundus. It is concluded that this selective adsorption therapy may delay the progression of DRA, and is worth considering for wide application.
