Effects of a reduced inner diameter of hollow fibers in hemodialyzers

Ronco, Claudio; Brendolan, Alessandra; Lupi, Andrea; Metry, George; Levin, Nathan W.

doi:10.1046/j.1523-1755.2000.00230.x

Cited by 118 publications

(69 citation statements)

References 8 publications

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“…One may hypothesize that FLC removal was higher because dialysis sessions were performed with a high-flux dialyzer with small inner diameter fibers which was not the case in the study of Granger et al [21]. Ronco et al [26] found that with reduction of the diameter of hollow fibers, internal filtration-backfiltration rates increase. This, in turn, increases the clearance of middle-sized molecules like vitamin B 12 and inulin.…”

Section: Discussionmentioning

confidence: 97%

Comparison between On-Line High-Efficiency Hemodiafiltration and Conventional High-Flux Hemodialysis for Polyclonal Free Light Chain Removal

Lamy

Henri²,

Lobbedez³

et al. 2014

Blood Purif

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Background: Polyclonal free light chains (FLC) are considered as middle molecular weight uremic toxins in chronic kidney disease. In this study, we investigate polyclonal FLC removal by comparing conventional high-flux hemodialysis (HD) and online high-efficiency hemodiafiltration (ol-HDF) in end-stage renal disease patients. Methods: We analyzed 31 chronic dialysis patients who were treated by HD then by postdilution ol-HDF during a prospective study. All patients were anuric and without monoclonal gammopathy. Serum pre- and postdialysis FLC were collected during 4 sessions: 1 HD session and 3 ol-HDF sessions. We calculated the reduction ratio using kinetic modeling. Results: The κ reduction ratio was higher with ol-HDF than with HD (66 ± 14 vs. 52 ± 13%, p < 0.001). However, the λ reduction ratio was not significantly higher with ol-HDF (37 ± 20 vs. 37 ± 15%, p = 0.67). Furthermore, predialysis κ- and λ-FLC increased with ol-HDF compared with HD (κ 155 ± 82 vs. 87 ± 47 mg/l, p < 0.05; λ 101 ± 46 vs. 72 ± 41 mg/l, p < 0.05). Postdialysis FLC levels were raised only for λ-FLC with ol-HDF (74 ± 39 vs. 53 ± 31 mg/l, p < 0.05) and were not significantly different for κ. Conclusions: This study shows that κ-FLC removal is better in ol-HDF compared with HD, whereas there is no difference in λ-FLC removal. Surprisingly, predialysis κ and λ levels are both increased in ol-HDF, which is disturbing since polyclonal excess of λ-FLC is associated with mortality in chronic kidney disease.

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Section: Discussionmentioning

confidence: 97%

Comparison between On-Line High-Efficiency Hemodiafiltration and Conventional High-Flux Hemodialysis for Polyclonal Free Light Chain Removal

Lamy

Henri²,

Lobbedez³

et al. 2014

Blood Purif

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“…The importance of trapping in the membrane pores may depend on the degree of filtration and back-filtration that occurs in the dialyzer. The amount of filtration and back-filtration depends on the net ultrafiltration rate and the inner diameter of the fibres, with a smaller inner diameter promoting more filtration and higher clearances of large solutes [18]. In practice, it is difficult to separate adsorption to the membrane surface from trapping in the pores.…”

Section: Discussionmentioning

confidence: 99%

Differences in solute removal by two high-flux membranes of nominally similar synthetic polymers

Ouseph

Hutchison

Ward

2008

Nephrology Dialysis Transplantation

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Background. Membranes fabricated from nominally similar polymers may be markedly different in chemical composition, morphology and geometry. To examine the relative importance of these factors to dialyzer performance, the removal of small and large uraemic toxins was determined for dialyzers containing 'polysulfone' membranes of different composition and morphology, with and without fibre undulations. Methods. Total removal and instantaneous clearances of urea, phosphorus, β 2 -microglobulin, leptin, angiogenin, complement factor D and immunoglobulin κ light chain were determined in randomized cross-over studies. Total solute removal was assessed from the pre-to post-dialysis change in plasma concentration and the total amount of solute recovered in the dialysate. Trapping of solute at the membrane was determined as the difference between solute lost from plasma water and solute recovered in the dialysate. Results. Total removal of urea and phosphorus was independent of the membrane composition and structure. Large molecule removal differed significantly between the two membranes, particularly for β 2 -microglobulin. The importance of trapping at the membrane as a mechanism of β 2 -microglobulin removal also differed significantly between the two membranes, with trapping being less important for the membrane with the greatest β 2 -microglobulin removal. As molecular size increased, the contribution of trapping at the membrane to solute removal increased and the difference between the two membranes decreased. Conclusions. High-flux membranes fabricated from nominally similar polymers may differ significantly in their ability to remove low molecular weight protein uraemic toxins.

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“…According to our previous studies [23,24,25,26,27,] we could model the theoretical behavior of a 1.3-1.5 m 2 dialyzer equipped with an HRO membrane in a reduced inner diameter configuration. A 1.5 dialyzer should be capable of generating an internal filtration of 40 mL/min at zero net filtration.…”

Section: Hdx: a New Therapy For A New Membranementioning

confidence: 99%

The Rise of Expanded Hemodialysis

Ronco

2017

Blood Purif

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114

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The low water permeability feature of original cellulosic membranes was considered an advantage in the absence of dialysis equipment that are capable of controlling water removal. The advent of ultrafiltration control systems led to the development and use of high-flux (HF) membranes that allowed improved middle molecule removal including β-2 microglobulin. Further advances in technology allowed better control over the structure and permeability of membranes. Different polymers and improved spinning modalities led to significant advances in solute removal and hemocompatibility. Inner surface modification produced a reduction in membrane thrombogenicity and protein-membrane interaction with a less tendency to fouling and permeability decay. Further evolution in technology led to the development of a new class of membranes referred to as protein-leaking membranes or super-flux or high cutoff (HCO). These membranes are more permeable than conventional HF membranes and allow some passage of proteins, including albumin. The rationale for these membranes is the need for increased clearance of low molecular weight proteins and protein-bound solutes. However, albumin loss in protein-leaking HCO membranes represents a limitation whose effect in patients is still controversial. The last evolution in the field of membranes is the development of a new class defined as “high retention onset” (HRO) due to the peculiar high sieving value in the middle to high molecular weight range. The introduction of HRO membranes in the clinical routine has enabled the development of a new concept therapy called “expanded hemodialysis.” Its simple set up and application offer the possibility to use it even in patients with suboptimal vascular access or even with an indwelling catheter. The system does not require particular hardware or unusual nursing skill. The quality of dialysis fluid is, however, mandatory to ensure a safe conduction of the dialysis session. This new therapy is likely to modify the outcome of end-stage kidney disease patients, thanks to the enhanced removal of molecules traditionally retained by current dialysis techniques.

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Effects of a reduced inner diameter of hollow fibers in hemodialyzers

Cited by 118 publications

References 8 publications

Comparison between On-Line High-Efficiency Hemodiafiltration and Conventional High-Flux Hemodialysis for Polyclonal Free Light Chain Removal

Comparison between On-Line High-Efficiency Hemodiafiltration and Conventional High-Flux Hemodialysis for Polyclonal Free Light Chain Removal

Differences in solute removal by two high-flux membranes of nominally similar synthetic polymers

The Rise of Expanded Hemodialysis

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