Effect of hemoperfusion with hexadecyl-immobilized cellulose beads on myocardial fatty acid imaging in hemodialysis patients: a case series study

Hexadecyl-immobilized porous cellulose beads (HICBs) can be used to remove β2-microglobulin, as well as several inflammatory cytokines and free protein-binding uremic toxins (PBUTs). Interleukin-6 and PBUT levels have been associated with oxidative stress and/or cardiovascular disease. In this retrospective study, we investigated the potential of direct hemoperfusion with HICBs to improve impaired myocardial fatty acid imaging in hemodialysis patients. We evaluated 24 hemodialysis patients who did not undergo percutaneous coronary intervention or coronary artery bypass grafting during the observation period. Among these patients, 12 who had been treated using HICB columns for more than 4 years were assigned to the HICBs group (mean observation period, 61.9 ± 16.3 months), while the remaining patients who had never undergone treatment with HICB columns were assigned to the non-HICBs group (mean observation period, 58.0 ± 12.2 months). Impaired myocardial fatty acid metabolism was assessed by single-photon emission computed tomography (SPECT) using 123 I-β-ethyliodophenyl pentadecanoic acid (BMIPP). Uptake on SPECT was graded in 17 segments on a 5-point scale (0, normal; 4, absent) and assessed as the BMIPP summed score (SS). While the HICBs group showed a lower mean β2-MG than the non-HICBs group, the other baseline clinical patient characteristics did not differ between the two groups. In the HICBs group, the second BMIPP SS was decreased significantly compared with the first BMIPP SS. A decrease in the BMIPP SS was observed in nine (75%) patients with the first BMIPP SS ≥ 6, and no change was observed in three patients with BMIPP SS ≤ 2. In the non-HICBs group, the second BMIPP SS was increased significantly compared with the first BMIPP SS. The improvement in myocardial fatty acid imaging suggests an improvement in the impaired myocardial microcirculation. We suggest that the use of direct hemoperfusion with HICBs may have improved the impaired myocardial microcirculation in hemodialysis patient through the removal of protein-bound toxins and inflammatory cytokines and might contribute towards improving the survival of dialysis patients.