Fluid and solute transfer characteristics in a dialyzer with a high-performance membrane

To date, many types of high-flux dialyzers with high-performance membranes have been developed. They seem to have a higher internal filtration flow rate (Q(IF)) because of a higher ultrafiltration coefficient. In the health reimbursement system in Japan, commercially available dialyzers are categorized into five types based on their β(2)-microglobulin clearance (K(BMG)) values. Although the K(BMG) value was not correlated strongly with the Q(IF) value for 26 types of commercially available dialyzers, almost all the dialyzers with a higher Q(IF) value had a higher KBMG value. These dialyzers seem to have a higher convective transport because of internal filtration in addition to diffusive transport. We measured the blood flow velocity in a cross-sectional plane of the dialyzer using pulse Doppler ultra-sonography to evaluate QIF. It is a useful method for the bedside monitoring because it is noninvasive to the patient and produces reliable data with a higher reproducibility. On the other hand, membrane fouling occurs more easily in higher Q(IF) dialyzers, compared with conventional dialyzers, because of the higher degree of membrane fouling. Internal filtration-enhanced hemodialysis (IFEHD) using these dialyzers, therefore, has the advantage of increasing solute removal efficiency by enhancing convective transport and the simultaneous disadvantage of decreasing solute removal efficiency by causing membrane fouling. Thus, IFEHD treatment should be performed using a dialyzer with a high-performance membrane to ensure that the advantage is superior to the disadvantage.