Effect of large-size dialysis membrane and hemofiltration/hemodiafiltration methods on long-term dialysis patients

Over 2,000 substances have been reported as uremic substances that are accumulated or produced due to renal failure that causes various clinical symptoms and complications. These substances include many medium to large molecular weight (MW) substances such as β(2)-microglobulin (β(2)-MG). In hemofiltration/hemodiafiltration (HD/HDF) therapy using high-performance membrane targeting less albumin loss and removal of β(2)-MG with a MW of 11,800, many cases showed insufficient improvement in the clinical outcome contrary to the decrease in serum β(2)-MG concentration. Focusing on these facts, HD/HDF therapy, which associates albumin loss, was implemented targeting the substances in the regions whose MWs are larger than β(2)-MG. HD/HDF therapy with protein-permeable membrane, compared to the therapy without protein-permeable membrane, achieved higher success in the removal of larger MW substances including β(2)-MG, cytokine, homocysteine and complement factor D, and higher clinical outcomes were reported, such as prevention of development of amyloidosis, anemia, osteoarthritis and pruritus, and improvement in life prognosis and biocompatibility in Japan. Therefore, in the current circumstances, it is essential to administer a treatment that can get as close to the glomerular basement membrane as possible, use dialysis membrane to effectively remove a wide range of substances, and aim to remove all of the substances accumulated in the body of patients with kidney dysfunction.