Abstract
A number of patients with long-term maintenance hemodialysis (HD) have been suffering from intractable bone and joint pain. Protein permeable hemodiafiltration is reported to be effective to reduce the pain of bone and joint in dialysis patient. To confirm this, various types of HPM dialyzers were used for the relief of shoulder pain on 17 patients with so called “dialysis shoulder”. Effect of dialysis on shoulder pain was assessed semiquantitatively by subjective symptoms and objective parameters. The removal capacities of LMWS were evaluated in an in vitro and in vivo systems and were attempted to correlate to the subjective improvement of dialysis shoulder. Seven of the eight patients on Duo Flux 150 improved their shoulder pain. Five of the 6 patients on CL-SS 15W, 5 of the 7 on BK-1.3P and 3 of the 5 on AM-UP-15 improved. None of the 4, however, could not reduced their pains with F-60. An in vitro and in vitro experiments showed that F-60 had a highest clearance on beta 2 microglobulin. On the other hand, Duo Flux 150 and CL-SS 15W had larger removal capacities on alpha 1 microglobulin and albumin. Judging from these results, dialyzer with high permeability to larger molecules than beta 2 microglobulin seems to have a better improvement for the pain of dialysis shoulder. There may be a possibility that substance (S) with larger molecular weight than beta 2 microglobulin is partly responsible for the regulation of the pain on dialysis related bone disease.
