Dialysis desiderata^*

Abstract

Microarray immunoassay systems, proteomics, separation of polypeptides in plasma by electrophoresis, and detection by mass spectrometry have shown that low molecular weight proteins, cytokines, and chemokines are present in high concentration in chronic kidney disease (CKD) subjects receiving dialysis. That these substances are also found in high concentration in sepsis, postcardiac bypass, acute respiratory distress, burns, and in brain death suggest that these syndromes have a common pathogenesis via a systemic inflammatory response syndrome (SIRS). It is not yet clear whether the profiles of such substances differ among the SIRS states. Dialysis membranes are not capable of removing these substances because such moieties exceed the molecular weight cutoff of modern synthetic hemodialysis membranes. On the other hand, sorbents directly in contact with blood or indirectly with filtered plasma, may be designed with pore structures with the capability of removing these substances. Such sorbents could be exploited in the treatment of CKD. While few human studies have been performed, animal experiments suggest that human trials should be initiated. The potential advantages of sorbents for CKD will be described.

A novel approach for blood purification: Mixed-matrix membranes combining diffusion and adsorption in one step

“…Protein-bound solutes are thought to contribute to uremic toxicity and are hardly removed by hemodialysis [37,38]. Adsorption has been proposed as a way to improve removal of these toxins [39,40] and it has been shown that the addition of activated carbon to the dialysate compartment of a hemodialyzer can improve protein-bound toxin removal [41,42]. Our first results suggest that the MMM could be suitable for the improvement of protein-bound toxin removal.…”