Abstract
Elevation of the plasma porphyrin concentration in long term hemodialysis patients has been implicated in the development of porphyria cutanea tarda (PCT)-like syndrome. In this study, we examined the removal of plasma porhyrins with standard membrane and high performance membrane dialyzers. We also investigated the relationship between the plasma porphyrin concentration and the metabolism of aluminum and iron in patients on maintenance hemodialysis. Plasma porphyrin levels pre- and post- hemodialysis were measured in 10 patients (including 1 PCT patient) with standard membrane dialyzers and in 11 patients with high performance membrane dialyzers. Plasma porphyrin levels (n=55), aluminum (n=38), iron (n=55) and ferritin (n=46) concentrations were also measured in those on maintenance hemodialysis. Plasma porphyrin levels were higher in the patients than in healthy subjects, especially in the patient with PCT. Significant removal of total porphyrin was observed with high performance membrane dialyzers (n=11, p<0.01) but not with standard dialyzers (n=10). Therefore, we compared the removal rates of total porphyrin and uroporphyrin between the standard dialyzer (AM-Neo-2000M) and three high performance dialyzers (AM-Neo-1501HP, KF-201C-1500 and H12-2400S). Significant removals of total porphyrin and uroporphyrin were observed with KF-201C-1500 (p<0.05) and H12-2400S (p<0.05). There was a positive correlation between plasma porphyrin and alum num (p<0.01), but the plasma porphyrin concentration correlated with neither iron nor ferritin. From these results, it is concluded that hemodialysis with certain high performance dialyzers may be effective for the removal of plasma porphyrin in patients on maintenance hemodialysis.
