A Study of the Basic Principles Determining the Performance of Several High-Flux Dialyzers

Jindal, Kailash; McDougall, James; Woods, Brian; Nowakowski, Ludwig; Goldstein, Marc B.

doi:10.1016/s0272-6386(89)80151-9

Cited by 59 publications

(24 citation statements)

References 4 publications

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“…This probably indicates adsorption of P2M onto the polyester-polymer alloy membrane from the begin ning of the session, a pattern not seen with the three other dialyzers. The first hour adsorption of P2M onto the polyester-polymer alloy membrane has also been shown by Stein et al [1], The adsorption of P2M seems to differ for the various types of membrane depending on their degree of hydrophobicity [14], Among the same dialyzers the surface area also seems to play a role [15]. From our study we can speculate that P2M adsorption onto the dial ysis membranes we studied is relatively high during the first hours of the session in polyester-polymer alloy mem brane, stable and rather small in cellulose diacetate and small during the first hour of the session in polysulfone and polyacrylonitrile membranes.…”

Section: Discussionmentioning

confidence: 75%

Clinical Evaluation of Four Different High-Flux Hemodialyzers under Conventional Conditions in vivo

et al. 1997

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Four types of high-flux hemodialyzers, Primus 2000 (high-flux polysulfone 2.0 m²), Altra-Flux 170 G (cellulose diacetate 1.7 m²), FLX-15 GW (polyester-polymer alloy 1.5 m²) and PAN-85 DX (polyacrylonitrile 1.7 m²) were evaluated in vivo. A total of 12 stable chronic hemodialysis patients participated in the study and each type of dialyzer was tested once in 9 of them. Blood samples for the measurement of BUN, creatinine, phosphate, uric acid, albumin and β₂-microglobulin (β₂M) were drawn before and 5 min after the end of the study dialysis. During dialysis, which was performed in all patients with a blood flow rate of 250 ml/min for 240 min, the dialysate (550-600 ml/min) was collected every hour and samples were drawn for the measurements of all the above substances. The mean total amount of low-molecular substances removed per session by each dialyzer was very close to 19.5 g for urea, 2.0 g for creatinine, 0.9 g for phosphate and 1 g for uric acid. The one-third (30-33%) of the above amounts were removed during the first hour of dialysis. Dialyz-ers’ clearances for creatinine and uric acid were significantly higher in Primus dialyzer comparing to FLX-15 GW (p < 0.05) while the clearance for urea showed a borderline significance (p = 0.055). No difference was found either among Altra-Flux 170 G, FLX-15 GW and PAN-85 DX or between Primus and PAN-85 DX dialyzers. Phosphate clearance did not show any difference among the four dialyzers. The lowest amount of albumin removed per session was 0.75 g by PAN-85 DX and the highest 1.8 g by FLX-15 GW, while the equivalents for β₂M were 80 mg by Altra-Flux 170 G and 142 mg by PAN-85 DX. A significant adsorption of β₂M on these dialysis membranes was indicated by the combination of a satisfactory serum β₂M reduction ratio (post-/ predialysis values = 0.52,0.77,0.60,0.55) with a reduced β₂M clearance (23.9, 13.6, 20.2, 25.1 ml/min). During the first hour of dialysis, in comparison to the following time, the highest amounts of albumin and β₂M (expressed as percentage of total) were removed by the Primus 2000 dialyzer. Our results indicate that under conventional conditions small differences in the surface area of the high-flux dialyzers are unimportant regarding the removal of low molecules. However, the composition of the membrane seems to play an important role in the removal of high-molecular substances.

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Section: Discussionmentioning

confidence: 75%

Clinical Evaluation of Four Different High-Flux Hemodialyzers under Conventional Conditions in vivo

et al. 1997

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“…The in vitro B|2 clearance for the Duofiux was 88 ml/min compared to 34-45 for the conventional dialyzers. The [T-microglobulin clear ance of the Duofiux was 11.4 ml/min [3] compared to no clearance by the conventional membranes. The in vivo ultrafiltration rate was 15 ml/h/mm Hg transmembrane pressure for the Duofiux compared to 3.5-5.0 for the conventional dialyzers.…”

Section: Methodsmentioning

confidence: 89%

“…The high-flux cellulose acetate membrane used had a higher vitamin B12 clearance than the conventional mem brane (88 ml/min vs. 34-45 ml/min) and a much higher P2-microglobulin clearance [3]. While the vitamin B|?…”

Section: Discussionmentioning

confidence: 96%

Effect of High-Flux Hemodialysis on Quality of Life and Neuropsychological Function in Chronic Hemodialysis Patients

et al. 1992

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The objective was to evaluate the effect of high-flux hemodialysis on quality of life, intra- and interdialytic symptoms and neuropsychological function. The study was double-blind single cross-over with random allocation to order of treatment. The patients were stable adult hospital hemodialysis patients. Both the conventional and high-flux membranes were cellulose acetate, the dialy-sate was bicarbonate, and dialysate sodium was held constant. The high-flux membrane had an ultrafiltration rate of 15 ml/h/mm Hg transmembrane pressure, a B₁₂ clearance of 88 ml/min and a β₂-microglobulin clearance of 11.4 ml/min. The values for the conventional membrane were 3.5-5.0, 34-45 and negligible. Each treatment period was 4 months. Twenty-two patients completed both phases of the cross-over. The KT/V value was higher during high-flux than conventional treatment; 1.42 versus 1.27(p < 0.05). There were no differences between high-flux and conventional treatment with respect to quality of life. Symptoms during dialysis were less severe during high-flux than conventional treatment for 12/14 items. Only 3 items reached statistical significance (0.05 > p > 0.01) and none were clinically significant. Symptoms between dialyses were less severe during high-flux than conventional treatment for 18/20 items. No single item had a statistically significant improvement but 3 had clinically important improvement. Among the 23 neuropsychological variables, none demonstrated statistically significant changes.

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“…Jindal et al [26] have reported beta-2-microglobulin sieving coefficients of 0.27 for the high flux cellulose acetate dialyzer used in this study compared to 0.47 and 0.43 for polysulfone membranes with ultrafiltration rates of 40 and 60. The beta-2-microglobulin clearance for the high flux cellulose acetate dialyzer was 11.4 compared to 17.3-54 ml/min for high flux polyacrylnitrile and polysulfone dialyzers.…”

Section: Discussionmentioning

confidence: 51%

Effect of High-Flux Hemodialysis on Cardiac Structure and Function among Patients with End-Stage Renal Failure

Churchill

Taylor

Tomlinson

et al. 1993

Nephron

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The effect of high flux hemodialysis on left ventricular function in ESRD patients was evaluated in a double blind, single cross-over, study comparing conventional to high flux hemodialysis. The subjects were 21 stable chronic hemodialysis patients. Ten were randomly allocated to the conventional-high flux sequence and 11 to the reverse sequence. The conventional membrane was the CD 3,500 or 4,000; the high flux membrane was the Duoflux (Althin Medical Inc., Miami Lakes, Fla.). Both were cellulose acetate and both were sterilized with ethylene oxide. The dialysate bicarbonate and sodium were held constant for the study. The ultrafiltration rates were 3.5-5.0 ml/h/mm Hg transmembrane pressure for the conventional and 15 ml/h/mm for the high flux membrane. The beta-2-microglobulin sieving coefficient was 0 for conventional and 0.27 for the high-flux membrane. The modest improvements in estimates of systolic function suggest a cardiac advantage in high-flux dialysis, the clinical impact of which requires further study.

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A Study of the Basic Principles Determining the Performance of Several High-Flux Dialyzers

Cited by 59 publications

References 4 publications

Clinical Evaluation of Four Different High-Flux Hemodialyzers under Conventional Conditions in vivo

Clinical Evaluation of Four Different High-Flux Hemodialyzers under Conventional Conditions in vivo

Effect of High-Flux Hemodialysis on Quality of Life and Neuropsychological Function in Chronic Hemodialysis Patients

Effect of High-Flux Hemodialysis on Cardiac Structure and Function among Patients with End-Stage Renal Failure

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