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논문분류	춘계학술대회 초록집
제목	Body MetricAdjusted Dialyzer Surface Area Improves 2-Microglobulin Reduction in High volume hemodiafiltration
저자	Hana Choi
출판정보	2026; 2026(1):
키워드	High volume-hemodiafiltration (HV-HDF), beta 2-Microglobulin, dialyzer surface area, Receiver Operating Characteristic (ROC) Curve
초록	Objectives: Despite the enhanced middle-molecule removal achieved with high-volume hemodiafiltration (HV-HDF), many patients do not reach sufficiently high β2-microglobulin (β2MG) reduction ratios (RR) up to 80%. In routine clinical practice, further increasing arteriovenous access blood flow or extending dialysis treatment time is often not feasible in real practice. Therefore, we investigated whether individualizing dialyzer surface area (DSA) to patients body metrics could optimize β2MG RR in Asian patients undergoing post-dilution online HDF (OL-HDF). Methods: We analyzed 80 patients undergoing post-dilution HV-HDF. We calculated DSA-to-body metric ratios such as DSA/dry body weight (DBW), DSA/body mass index (BMI), and DSA/body surface area (BSA). Receiver operating characteristic (ROC) curve analyses were performed to identify optimal cut-off values for predicting achievement of β2MG RR ≥80%. Results: The mean patient age was 65.6 ± 13.0 years; mean dialysis vintage was 70.8 ± 68.6 months, and mean vascular access blood flow rate (Qb) was 301.2 ± 13.4 ml/min. Mean DBW was 62.1 ± 15.4 kg, BMI 23.3 ± 4.9 kg/m², and BSA 1.7 ± 0.2 m². The mean convection volume was 23.5 ± 1.5 L/session, and mean β2MG RR was 74.2 ± 6.0 %. In ROC analyses for predicting β2MG RR ≥80%, DSA/BSA (AUC 0.81; cut-off 1.27; sensitivity 100.0%; specificity 62.5%) and DSA/DBW (AUC 0.81; cut-off 0.03 m²/kg; sensitivity 100.0%; specificity 51.39%) demonstrated excellent performance. DSA/BMI showed an AUC of 0.76 with a cut-off of 0.10 (sensitivity 62.5%; specificity 84.72%). Conclusion: Adjusting DSA to patient body metrics, such as using DSA/BSA ≥ 1.27 or DSA/DBW ≥ 0.03 m²/kg, may provide a practical strategy to optimize β2MG clearance in HV-HDF in Asian patients. These body metric-adjusted DSA indices also serve as clinically to identify and guide dialyzer selection for patients who require greater middle -molecule clearance.
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