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Endotoxemia after high cutoff hemodialysis for treatment of patient with multiple myeloma can be prevented by using ultrapure dialysate: A case report
Author(s) -
Gong Dehua,
Ji Daxi,
Zhang Kaiyue,
Huang Xianghua,
Huang Gaoyuan,
Xu Bin,
Liu Zhihong
Publication year - 2013
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/j.1542-4758.2012.00757.x
Subject(s) - medicine , hemodialysis , multiple myeloma , cutoff , intensive care medicine , quantum mechanics , physics
To report endotoxemia presented in a case with multiple myeloma ( MM ) treated by high cutoff hemodialysis ( HCO ‐ HD ) being prevented by using ultrapure dialysate. A female inpatient with MM received six times HCO ‐ HD ( HCO 2100 dialyzer) within 3 weeks after initiation of a chemotherapy based on vincristine + epirubicin + dexamethasone protocol. Conventional dialysate was used in the first three times and then changed to ultrapure dialysate due to elevation of body temperature after HCO ‐ HD . Free light chains ( FLC ) and endotoxin levels in blood and dialysate were monitored. After six times HCO ‐ HD , her serum FLC λ decreased from 4689 mg/L to 492.7 mg/L, with a trend of decline of serum creatinine. The clearance, reduction ratio, and removal amount of FLC λ was 38.4 mL/min, 71.0–85.2%, and 9.06–18.02 g, respectively, in the setting of dialysate flow rate 500 mL/min, while in the setting of dialysate flow rate 200 mL/min, the removal efficacy of FLC λ was lower than the former. A rise of body temperature up to 38.5°C after treatment and endotoxemia (endotoxin levels 0.122 EU/mL) was found when using conventional dialysate (endotoxin levels 0.112–0.145 EU/mL), but not seen after changing to ultrapure dialysate. Combined with appropriate chemotherapy, HCO ‐ HD can effectively remove and reduce blood FLC . Attention should be paid to the endotoxemia and the rise of temperature after treatment when conventional dialysate is used, which can be prevented by using ultrapure dialysate.