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A new polymethylmethacrylate membrane for hemodialysis
M Bonomini1, B Fiederling, T Bucciarelli
1Institute of Nephrology, G. D'Annunzio University, Chieti, Italy.
Abstract:
High molecular weight (MW) solutes are not removed during conventional hemodialysis (HD), and their accumulation is thought to play a role in some long-term HD complications (anemia, bone and joint pain, neuropathy, itching). The present trial was conducted to evaluate the removal capacity during in vivo HD of a new polymethylmethacrylate (PMMA) membrane (Filtryzer BK-F, 1.3 m2) compared to conventional PMMA (BK-P, 1.6 m2) and to cellulose acetate (CA, 1.3 m2). BK-F dialyzers, with a pore size of 100 A degrees and 62% porosity, are designed to remove high MW substances. Ten stable anuric RDT patients (53 +/- 13 years) were treated for one week with each membrane in a randomized sequence. Plasma concentrations of creatinine, BUN and beta 2-microglobulin (beta 2-M) were measured before (b) and after (a) HD to determine the reduction rate for these substances (%). Beta 2-M concentration after HD was corrected for changes in distribution volume. Samples of spent dialysate were collected after 3 minutes, 120 minutes and at the end of HD sessions, and appropriately treated and concentrated for HPLC analysis. The reduction rate for BUN and creatinine was similar for the 3 membranes. BK-F showed a higher beta 2-M reduction rate than BK-P (p < 0.005) or CA (p < 0.0001). HPLC analysis of dialysate showed prevalent peaks < 4 kilodaltons (kDa) throughout HD for BK-P and CA. Solutes > 10 kDa were infrequently detected. Peak profile during HD with BK-F was quite different, showing a predominant peak > 50 kDa which also included albumin. However, albumin loss significantly decreased after 120 minutes and at the end of dialysis compared with the 3-minute values, and was lower than that reported in CAPD patients. With BK-F a peak of MW > 500 kDa was also detected which previous studies indicated as a range characterized by the presence of erythropoiesis inhibitors. Use of the BK-F membrane in HD could afford satisfactory removal of high MW substances, thereby preventing or controlling some long-term HD complications such as anemia or beta 2-M amyloid formation.
Insights
A new hemodialysis (HD) membrane, Filtryzer BK-F, effectively removes high molecular weight (MW) solutes like beta 2-microglobulin (beta 2-M). This advanced membrane shows promise in managing long-term HD complications such as anemia and amyloid formation.
Area of Science:
- Nephrology
- Biomaterials Science
Background:
- High molecular weight (MW) solutes accumulate during conventional hemodialysis (HD), contributing to long-term complications.
- These complications include anemia, bone and joint pain, neuropathy, and itching.
Purpose of the Study:
- To evaluate the in vivo HD removal capacity of a new polymethylmethacrylate (PMMA) membrane (Filtryzer BK-F).
- To compare BK-F's performance against conventional PMMA (BK-P) and cellulose acetate (CA) membranes for high MW solute removal.
Main Methods:
- A randomized crossover trial involving ten stable anuric RDT patients.
- Patients were treated with BK-F, BK-P, and CA membranes for one week each.
- Plasma concentrations of creatinine, BUN, and beta 2-microglobulin (beta 2-M) were measured pre- and post-HD.
- Dialysate was analyzed using HPLC to assess MW solute profiles.
Main Results:
- The reduction rates for BUN and creatinine were similar across all three membranes.
- BK-F demonstrated significantly higher beta 2-M reduction rates compared to BK-P and CA (p < 0.005 and p < 0.0001, respectively).
- HPLC analysis revealed BK-F effectively removed solutes > 50 kDa, including those > 500 kDa, unlike BK-P and CA which primarily removed < 4 kDa solutes.
Conclusions:
- The BK-F membrane offers superior removal of high MW substances during hemodialysis.
- This enhanced removal capacity may help prevent or manage long-term HD complications like anemia and beta 2-M amyloidosis.