Chronic kidney disease (CKD) is acknowledged worldwide to be a grave threat to public health, with the number of US end-stage kidney disease (ESKD) patients increasing steeply from 10,000 in 1973 to 703,243 in 2015. Protein-bound uremic toxins (PBUTs) are excreted by renal tubular secretion in healthy humans, but hardly removed by traditional haemodialysis (HD) in ESKD patients. The accumulation of these toxins is a major contributor to these sufferers’ morbidity and mortality. As a result, some improvements to dialytic removal have been proposed, each with their own upsides and drawbacks. Longer dialysis sessions and hemodiafiltration, though, have not performed especially well, while larger dialyzers, coupled with a higher dialysate flow, proved to have some efficiency in indoxyl sulfate (IS) clearance, but with reduced impact on patients’ quality of life. More efficient in removing PBUTs was fractionated plasma separation and adsorption, but the risk of occlusive thrombosis was worryingly high. A promising technique for the removal of PBUTs is binding competition, which holds great hopes for future HD. This short review starts by presenting the PBUTs chemistry with emphasis on the chemical interactions with the transport protein, human serum albumin (HSA). Recent membrane-based strategies targeting PBUTs removal are also presented, and their efficiency is discussed.
In this paper, we propose an optimized protocol to synthesize reproducible, accurate, sustainable integrally skinned monophasic hybrid cellulose acetate/silica membranes for ultrafiltration. Eight different membrane compositions were studied, divided into two series, one and two, each composed of four membranes. The amount of silica increased from 0 wt.% up to 30 wt.% (with increments of 10 wt.%) in each series, while the solvent composition was kept constant within each series (formamide/acetone ratio equals 0.57 wt.% in series one and 0.73 wt.% in series two). The morphology of the membranes was analyzed by scanning electron microscopy and the chemical composition by Fourier transform infrared spectroscopy, in attenuated total reflection mode (FTIR-ATR). Mechanical tensile properties were determined using tensile tests, and a retest trial was performed to assess mechanical properties variability over different membrane batches. The hydraulic permeability of the membranes was evaluated by measuring pure water fluxes following membrane compaction. The membranes in series two produced with a higher formamide/acetone solvent ratio led to thicker membranes with higher hydraulic permeability values (47.2–26.39 kg·h−1·m−2·bar−1) than for the membranes in series one (40.01–19.4 kg·h−1·m−2·bar−1). Results obtained from the FTIR-ATR spectra suggest the presence of micro/nano-silica clusters in the hybrid membranes of series one, also exhibiting higher Young’s modulus values than the hybrid membranes in series two.
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