Dialysis – Transplantation
Kidney International (2001) 60, 319–323; doi:10.1046/j.1523-1755.2001.00802.x
Influence of various hemodialysis membranes on the plasma (1
3)-
-D-glucan level
Hiroko Kanda, Kanae Kubo, Ken Hamasaki, Yoshinobu Kanda, Akihide Nakao, Tadaichi Kitamura, Toshiro Fujita, Kazuhiko Yamamoto and Toshihide Mimura
Department of Internal Medicine, University of Tokyo; Stem Cell Transplant Unit, National Cancer Center Hospital; and Department of Hemodialysis and Apheresis, University of Tokyo, Tokyo, Japan
Correspondence: Hiroko Kanda, M.D., Department of Internal Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail: hkanda-tky@umin.ac.jp
Received 1 August 2000; Revised 17 January 2001; Accepted 26 January 2001.
Abstract
Influence of various hemodialysis membranes on the plasma (13)-
-D-glucan level.
Background
Recently, invasive fungal infections have increased significantly because of the growing number of immunocompromised hosts. The measurement of plasma (13)-
-D-glucan has been proposed as a useful diagnostic tool for deep mycosis. In this study, we analyzed the alteration of the plasma (13)--D-glucan concentration by using different kinds of hemodialysis (HD) membranes in end-stage renal disease (ESRD) patients and estimated its half-life.
Methods
Twenty-seven patients with ESRD without known fungal infections (with a median age of 66 years old) were enrolled in this study. Cellulose triacetate (CTA) membrane, cellulose (Cu) membrane, and polymethyl methacrylate (PMMA) membrane were used in three consecutive initiations of HD and plasma (13)--D-glucan concentration was measured before and after each HD session.
Results
The level did not change between before and after HD when CTA and PMMA membranes were used. In contrast, the plasma (13)--D-glucan level increased greatly after HD using the Cu membrane (from 9.4 to 332 pg/mL in median). Hypothesizing that the plasma (13)--D-glucan level declines exponentially, its median half-life is estimated at 20 hours, which is not affected by hepatic or renal function.
Conclusions
Because the plasma (13)--D-glucan level increases dramatically after HD using the Cu membrane, dialyzers with Cu membrane should be avoided for HD in patients with suspected deep mycosis. The measurement of plasma (13)--D-glucan is also useful for the patients with hepatic or renal failure.
Keywords:
dialysis membranes, cellulose membrane, deep mycosis, fungal infection
