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. 2025 Aug 5;54(11):1-10.
doi: 10.1159/000546771. Online ahead of print.

Direct Hemoperfusion with Polymethylmethacrylate for Hemodialysis Patients with Dialysis-Related Amyloidosis

Shoko Yamazaki  1 , Daisuke Miyauchi  1 , Atsushi Hashimoto  2 , Takahiro Tanaka  2 , Mototsugu Tanaka  2 , Hisaki Shimada  3 , Yuji Ishii  4 , Koji Matsuo  5 , Akio Kasai  6 , Yutaka Koda  7 , Kokichi Saito  8 , Junichi Hoshino  9 , Shinichi Nishi  10 , Suguru Yamamoto  1
Affiliations

Direct Hemoperfusion with Polymethylmethacrylate for Hemodialysis Patients with Dialysis-Related Amyloidosis

Shoko Yamazaki et al. Blood Purif. .

Abstract

Introduction: Dialysis-related amyloidosis (DRA) is a serious complication in patients undergoing long-term dialysis that leads to conditions such as carpal tunnel syndrome and destructive spondyloarthropathy. Improved removal of the precursor protein β2-microglobulin (β2-m) is considered an effective treatment strategy for DRA. Polymethylmethacrylate (PMMA) membranes have the capacity to adsorb β2-m in dialysis filters, suggesting that direct hemoperfusion with PMMA in addition to standard dialysis may enhance β2-m removal.

Methods: This prospective cohort study included 10 patients undergoing hemodialysis, who were diagnosed with DRA. The participants were treated with dialysis filter alone during visit 1, both standard dialysis filter and PMMA cartridges (FT-75, volume 75 cm3) during visits 2-4, and FT-145 PMMA cartridges (volume 145 cm3) during visits 5-7. The removal rates and clearances of β2-m were quantified. We also assessed the removal of α1-microglobulin (α1-m), matrix metalloproteinase-3 (MMP-3), interleukin-6 (IL-6), and tumor necrosis factor-a (TNF-α), which may be associated with DRA symptoms.

Results: PMMA cartridge had increased β2-m removal rates compared to dialysis filter alone for treatment duration of 240 min. Similarly, the removal rates of α1-m and MMP-3 were higher with PMMA cartridges than with dialysis filter alone. β2-m, α1-m, and MMP-3 clearance improved with the addition of PMMA cartridges, depending on the cartridge size. The removal rates of IL-6 and TNF-α were higher with PMMA cartridges than with dialysis filter alone at 30 min, but not at 240 min.

Conclusion: Direct hemoperfusion with PMMA is an effective method for removing β2-m in hemodialysis patients with DRA. Beneficial effects were also observed for the removal of α1-m and MMP-3. Further research is required to evaluate the long-term efficacy of this approach in managing DRA.

Keywords: Dialysis-related amyloidosis; Hemoperfusion; Polymethylmethacrylate; β2-microglobulin.

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Conflict of interest statement

This study was commissioned by Toray Medical, Inc., to Niigata University. The authors declare no competing financial interests.

Figures

Fig. 1.
Fig. 1.
Comparison of β2-m RRs in each treatment condition. a At 30 min. b At 60 min. c At 120 min. d At 240 min. Data are presented as mean ± SD. The RRs were analyzed using a paired t test. e Time course of β2-m RRs at each study visit. Solid line: visit 1; dotted line: visit 4; dashed line: visit 7. SD, standard deviation.
Fig. 2.
Fig. 2.
Comparison of β2-m clearance in each treatment mode. a At 30 min. b At 60 min. c At 120 min. d At 240 min. Black bars show mean values of the total clearances, and gray bars show mean clearance values of the PMMA cartridges. The clearances were analyzed using a paired t test.
Fig. 3.
Fig. 3.
Comparison of α1-m RRs in each treatment condition. a At 30 min. b At 60 min. c At 120 min. d At 240 min. Data are presented as mean ± SD. The RRs were analyzed using a paired t test. e Time course of α1-m RRs at each study visit. Solid line: visit 1; dotted line: visit 4; dashed line: visit 7. SD, standard deviation.
Fig. 4.
Fig. 4.
Comparison of α1-m clearance in each treatment mode. a At 30 min. b At 60 min. c At 120 min. d At 240 min. Black bars show mean values of the total clearance, and gray bars show mean clearance values of the PMMA cartridges. The clearances were analyzed using a paired t test.
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