Application of cystatin C reduction ratio to high-flux hemodialysis as an alternative indicator of the clearance of middle moleculesopen access
- Authors
- Park, Joon-Sung; Kim, Gheun-Ho; Kang, Chong Myung; Lee, Chang Hwa
- Issue Date
- Feb-2010
- Publisher
- 대한내과학회
- Keywords
- Beta 2-microglobulin; Cystatin C; Dialysis
- Citation
- Korean Journal of Internal Medicine, v.25, no.1, pp.77 - 81
- Indexed
- SCOPUS
KCI
- Journal Title
- Korean Journal of Internal Medicine
- Volume
- 25
- Number
- 1
- Start Page
- 77
- End Page
- 81
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/175462
- DOI
- 10.3904/kjim.2010.25.1.77
- ISSN
- 1226-3303
- Abstract
- Background/Aims: Although high-flux (HF) dialyzers with enhanced membrane permeability are widely used in current hemodialysis (HD) practice, urea kinetic modeling is still being applied to indicate the adequacy of both low-flux (LF) and HF HD. In comparison with urea (molecular weight, 60 Da) and β2-microglobulin (β2MG, 12 kDa), cystatin C (CyC, 13 kDa) is a larger molecule that has attractive features as a marker for assessing solute clearance. We postulated that CyC might be an alternative for indicating the clearance of middle molecules (MMs), especially with HF HD. Methods: Eighty-nine patients were divided into LF and HF groups. Using single pool urea kinetic modeling, the urea reduction ratio (URR) and equilibrated Kt/Vurea (eKt /Vurea) were calculated. The serum CyC concentrations were measured using particle-enhanced immunonephelometry. As indices of the middle molecular clearance, the reduction ratios of β2MG and CyC were calculated. Results: The β2MG reduction ratio (β2MGRR) and CyC reduction ratio (CyCRR) were higher in the HF group compared to the LF group. However, the URR and eKt/Vurea did not differ between the two groups. The CyCRR was significantly correlated with the eKt/Vurea and β2MGRR (r = 0.47 and 0.69, respectively, both p < 0.0001). Conclusions: Compared to the LF dialyzer, the HF dialyzer removed CyC and β2MG more efficiently. Unlike the β2MGRR, the CyCRR was correlated with the eKt/Vurea and β2MGRR. This study suggests a role for the CyCRR as an alternative indicator of the removal of MMs.
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