Improvement of dialyzer compatibility by reduction of membrane surface area

The present study was devised to investigate, whether reduction of membrane surface area would contribute to enhanced dialyzer membrane compatibility. Therefore, 10 hemodialysis patients were dialyzed with three different cuprophan dialyzers, displaying membrane surface areas of 0.9 m2, 1.2 m2, and 1.8 m2. As an index of biocompatibility release of granulocyte elastase and secretion of granulocyte lactoferrin were determined by enzyme-linked immunoassays. With the three cuprophan membranes, marked leukopenia occurred 15 min after the start of hemodialysis, without significant distinction between the different membranes. On the other hand, the release of leukocyte elastase was strictly dependent on the membrane surface area. Thus, at the end of dialysis, plasma levels of elastase were as follows: 0.9 m2: 255 +/- 51; 1.2 m2: 356 +/- 65; 1.8 m2: 471 +/- 56 ng/ml. The magnitude of secretion of leukocytic lactoferrin was also dependent on membrane surface area. Therefore, the increment during dialysis was 300% with the 1.2 m2 membrane compared to 650% using a 1.8 m2 dialyzer. Based upon these data, we concluded that, using measurements of granulocyte degranulation as an index of biocompatibility, reduction of membrane area resulted in a marked improvement of membrane compatibility.