Comparison of Blood Loss with Different High-Flux and High-Efficiency Hemodialysis Membranes

Abstract

Iron deficiency is a common problem in patients on chronic HD. Earlier studies have shown significant blood loss per HD session. To identify whether the new more biocompatible high-flux or high-efficiency membranes are also responsible for significant blood loss during HD, we quantitated the amount of blood loss associated with 4 commonly used membranes (F-50, F-80, CA-210, and CT-190). The residual blood in each compartment of extracorporeal circuit was quantitated after total lysis of the red blood cells (RBC), hemoglobin assay, and calculation of the RBC volume using the patient’s hemoglobin and hematocrit concentrations just prior to the study. The average residual RBC volume in different membranes was 0.2–0.3 ml. The residual RBC volume in the dialysis lines (arterial or venous) was 0.1–0.2 ml and did not correlate with the residual RBC volume in the dialysis membranes. The residual RBC volume in the whole extracorporeal circuit (HD membrane, arterial and venous lines) ranged from 0.5 to 0.6 ml. It was significantly higher with F-50 vs. CA-210. The residual RBC volume in the dialysis membrane was significantly higher in the F-80 vs. CA-210 and CT-190 dialyzers. There was also significant difference in the residual RBC volume in the arterial lines of F-50 vs. CT-190, and F-50 vs. F-80 dialyzers. Conclusion: Our results demonstrate for the first time that the total RBC loss per HD session is minimal in chronic HD patients.

Iatrogenic Iron Overload in Dialysis Patients at the Beginning of the 21st Century

“…Blood loss has been estimated at 0.3 mL/session [ 27 ] and 0.9 mL/session [ 28 ] with modern dialysis membranes, and blood-line losses at 0.2 mL/session [ 27 ]. Thus, assuming losses of 1.1 mL per session, annual losses owing to the hemodialysis technique itself during conventional hemodialysis (3 sessions/week, 150 sessions/year) represent about 165 mL (Table 1 ).…”

Red Blood Cell Damage from Extracorporeal Circulation in Hemodialysis

“…The reported quantity of residual blood left in the extracorporeal circuit after rinsing range from 0.01 to 23.9 ml (RBC) (11,12). Correlation between net fluid removal (ultrafiltration) and residual blood was claimed (12), but not confirmed in a later paper (13).…”

Upper Limit of Serum Ferritin: Misinterpretation of the 2006 KDOQI Anemia Guidelines

“…Iron management is an important aspect of care for patients on hemodialysis. Iron deficiency occurs frequently, because of blood retention in the dialysis lines and filter, reduced absorption of dietary iron, and increased demand for iron induced by erythropoiesis stimulating agent (ESA) treatment (1–6). Failure to detect and treat iron deficiency results in inefficient ESA therapy.…”