Effects of internal filtration on the solute removal efficiency of a dialyzer

To improve solute removal efficiency, several types of dialyzers with enhanced internal filtration were introduced for clinical application. In these dialyzers, enhanced internal filtration increased convective transport of the solute, in addition to diffusive transport. In this study, the effects of internal filtration on solute removal efficiency were examined by both analytic and experimental studies. Internal filtration is affected by blood (Q(B)) and dialysate (Q(D)) flow rates; the patient's hematocrit and plasma level of total protein; and the effective length (L(eff)), inner diameter (D), and density ratio (DR) of the hollow fibers. An analytic model was introduced for the estimation of the changes in mass and momentum along the dialyzer. It clarified the effects of these parameters on maximum internal filtration flow rate (Q(IF)) and clearance (K) of urea (60 daltons), vitamin B(12) (1,355), and myoglobin (17,000). As a result of the analytic study, Q(IF) was increased, resulting in a smaller D, a longer L(eff), and a larger DR value. Several types of dialyzers with the same cellulose triacetate membrane, produced by Toyobo Co, Ltd., Ohtsu, Japan, and Nissho Corporation, Kusatsu, Japan, were used for the experimental study. An in vitro evaluation using myoglobin solution showed the same trends as found in the analytic study. For example, a dialyzer with 150 microm of D has a 72.0 ml/min myoglobin K value, much higher than that of 53.7 ml/min for a dialyzer with 200 microm of D under constant Q(B) (300 ml/min) and DR (50%) values. Development of a dialyzer with enhanced internal filtration, however, should take the patient's safety into account, and hemolysis and endotoxin invasion from the dialysate to the patient should be avoided.