Use of Peritoneal Dialysis in the Treatment of Patients with Renal Failure and Paraproteinemia

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Abstract
The effect of alterations in dwell time, dialysate dextrose concentration, and nitroprusside on immunoglobulin removal during peritoneal dialysis and a comparison of plasmapheresis versus peritoneal dialysis on immunoglobulin removal was studied. 1 h of plasmapheresis removed approximately 100 times as much IgG and 50 times as much IgM and IgA as 1 h of peritoneal dialysis. Nitroprusside added to peritoneal dialysate doubled the hourly removal rate of IgG using 1- and 8-hour cycles and increased IgA and IgM removal by 25 and 10%, respectively, using 8-hour cycles. It was estimated that peritoneal dialysis with nitroprusside added to peritoneal dialysate augments intact immunoglobulin clearance (above endogenous clearance) by approximately 10%. We hypothesized that peritoneal dialysis could significantly increase light-chain removal and thereby may be efficacious in the treatment of light chain related amyloid formation and light chain induced renal failure.