Background: On-line hemodiafiltration (OL-HDF) has been generally provided mainly by the postdilution method in Europe and the rest of the world; however, in Japan, it has been provided mostly by the predilution method in order to ameliorate dialysis-related symptoms of dialysis patients by removing larger low molecular weight proteins. This study aimed to elucidate the removal properties of a newly launched asymmetric triacetate (ATA) membrane in OL-HDF both in the postdilution and predilution comparison with other synthetic polymer membranes. Methods: Six patients treated by OL-HDF at the Kawashima Hospital Group were randomly chosen for each membrane study. The removal properties of low molecular weight proteins were evaluated by β 2-microglobulin (β 2-MG), α 1microglobulin (α 1-MG), albumin leakage, selective removal index of α 1-MG for albumin, and transmembrane pressure for each treatment group. Two types of ATA membrane were evaluated in the study: FIX-S with mild protein permeability and FIX-U with higher protein permeability in the comparisons with other three types of synthetic polymer membranes. Results: The removal rate of β 2-MG showed almost no significant differences between the postdilution and predilution methods in most membrane groups at around 75-80% without relations to the membrane material and the substitution volume. The removal rates of α 1-MG were markedly different depending on the dilution method of HDF, the membranes, and the substitution volume. Generally, the removal rates of α 1-MG were better in the postdilution than the predilution but the selective removals of α 1-MG were better in the predilution. The high volume OL-HDF had the risk of excessive albumin leakage in a certain membrane choice. In the FIX series, the removal rates of α 1-MG were sufficient both in the postdilution and predilution with the increase of the substitution volume with suppressing the albumin leakage during the dialysis session. Especially, FIX-U showed higher removal of α 1-MG with suppressing the albumin leakage. Conclusions: The newly launched ATA membrane could remove α 1-MG, selectively suppressing the excessive albumin leakage and increasing the substitution volume safely even in high-volume postdilution.
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