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HDF Beta-2 Microglobulin Clearance — ESENeph MCQ

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ModerateHaemodialysisHDF Beta-2 Microglobulin ClearanceESENeph

A 55-year-old man with CKD G5D on haemodialysis has been on dialysis for 15 years. He has developed beta-2 microglobulin amyloidosis with shoulder pain, carpal tunnel syndrome, and bone cysts. He has been switched from low-flux to high-flux HD. What additional modality change could further improve beta-2 microglobulin clearance?

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Correct answer: C — Switch to online haemodiafiltration (HDF) – the convective component provides superior middle molecule clearance compared to high-flux HD alone

Online HDF combines diffusive and convective clearance. The convective component is particularly effective for middle molecules like beta-2 microglobulin (11.8 kDa). The CONVINCE trial showed survival benefit with high-volume HDF (≥23 L convection). For beta-2 microglobulin specifically, HDF achieves approximately 70-80% reduction per session compared to 50-60% with high-flux HD. While established DRA cannot be reversed by dialysis modality change, progression may be slowed. Kidney transplantation remains the definitive treatment as it restores renal beta-2 microglobulin clearance.

Reference: CONVINCE Trial – NEJM 2023; ERA-EDTA – HDF Position 2023