Albumin Loss in On-Line Hemodiafiltration

Combarnous, François; Tetta, Ciro; Cellier, C.; Wratten, Mary Lou; Custaud,; Catheu, T. De; Fouque, Denis; David, S.; Carraro, Gianni; Laville, Maurice

doi:10.1177/039139880202500306

Cited by 35 publications

(26 citation statements)

References 16 publications

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“…The albumin loss ranged from 0.3 to 18 g per session below the 10th reuse. In a recent study, Combarnous et al [24] found in HDF an average albumin loss 3.99 B 1.81 g per session, with a range of 1.09 to 6.89 in the individual patients. Many plasmatic factors, such as the lipid, fibrinogen and protein concentration, but also factors related to structural and functional modification of the plasma protein may interfere in handling and processing during hemodialysis.…”

Section: Discussionmentioning

confidence: 94%

Protein Loss in On-Line Hemofiltration

et al. 2004

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Background: The albumin serum level is one of the most important nutritional indices and is directly correlated to the uremic patient’s hemodialysis outcome. One of the factors that can interfere with protein metabolism is the possible loss of albumin through the dialysis membrane that can contribute to keeping levels chronically low, especially for high-flux convective treatments requiring high permeability membranes and the removal of high volumes of plasma water. Methods: Twenty stable patients undergoing chronic renal replacement therapy for at least 3 months were included. Each patient performed four hemofiltration treatments, 2 in post-dilution and 2 in pre-dilution (post-D, pre-D) with a polyamide membrane (Poliflux, 2.1 m²). Results: The amount of albumin found in the ultrafiltrate was 2.9 ± 1.5 g in post-D and 1.7 ± 0.8 g in pre-D (p < 0.01). Albumin loss during online HF was lower than 3 g per treatment, and significantly lower in pre-D than in post-D. Furthermore, we observed a correlation between the transmembrane pressure and the albumin loss in both techniques, but with different slopes (y = 0.351x – 10.014 in post-dilution and y = 0.0639x + 8.2403 in pre-dilution; p = 0.01): the same transmembrane pressure determines larger albumin losses in post-dilution than in pre-dilution. Conclusions: Convective treatments that utilize high exchange volume can be performed with no risk of a significant albumin loss, particularly in pre-D where the proteic component’s contact with the dialysis membrane is lower. In post-dilution the transmembrane pressure is a relevant factor in determining the protein loss.

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Section: Discussionmentioning

confidence: 94%

Protein Loss in On-Line Hemofiltration

et al. 2004

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“…Could protein-leaking membranes be used for hemodiafiltration? Use of protein-leaking membranes for hemodiafiltration results in an albumin loss of up to 7 g/treatment (28,56,58). To date, there are no long-term studies to show whether this level of albumin loss has an impact on serum albumin.…”

Section: Can Protein-leaking Membranes Have An Impact On Uremic Toxinmentioning

confidence: 99%

Protein-Leaking Membranes for Hemodialysis

Ward¹

2005

Journal of the American Society of Nephrology

102

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A new class of membranes that leak protein has been developed for hemodialysis. These membranes provide greater clearances of low molecular weight proteins and small protein-bound solutes than do conventional high-flux dialysis membranes but at the cost of some albumin loss into the dialysate. Protein-leaking membranes have been used in a small number of clinical trials. The results of these trials suggest that protein-leaking membranes improve anemia correction, decrease plasma total homocysteine concentrations, and reduce plasma concentrations of glycosylated and oxidized proteins. However, it is not clear yet that routine use of protein-leaking membranes is warranted. Specific uremic toxins that are removed by protein-leaking membranes but not conventional high-flux membranes have not been identified. It is also unclear whether protein-leaking membranes offer benefits beyond those obtained with conventional high-flux membranes used in convective therapies, such as hemofiltration and hemodiafiltration. Finally, the amount of albumin loss that can be tolerated by hemodialysis patients in a long-term therapy has yet to be determined. Protein-leaking membranes offer a new approach to improving outcomes in hemodialysis, but whether their benefits will outweigh their disadvantages will require more basic and clinical research.

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“…22 The loss of albumin with a molecular weight of about 66 kDa through the hemofilter membrane was also a common phenomenon in the clinic, too. 23 It is theoretically possible that Epo with a molecular weight of 30.4 kDa can also be filtered across the membrane, though there are no reports about the loss of Epo in the process of hemodialysis or hemofiltration currently. We suppose that the loss of Epo is little, if any, due to the adsorption of proteins on the membrane and limitation of dialysis time and transmembrane pressure.…”

Section: Discussionmentioning

confidence: 99%

Construction of an Erythropoietin-Expressing Bioartificial Renal Tubule Assist Device

et al. 2011

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Methods: A eukaryotic expression vector pcDNA3.1-hEpo was constructed by standard cloning methods. G418 was applied to select for a stable erythropoietin (Epo) expression cell clone. Cell viability and cell growth curve were generated with MTT chromatometry. HK-2 cells were transfected with pcDNA3.1-hEpo, cultured, and then seeded into the hollow fibers of high-flux hemofilters. The expression levels of Epo in the culture supernatants were detected by enzyme-linked immunosorbent assay (ELISA). The inulin leak rate and the transport of Na + and glucose (Glu) of the Epo-expressing bioartificial renal tubule assist device (RAD) were determined and compared with the conventional RAD. The specific inhibition of the transport by ouabain and phlorizin was determined. Results: The Epo expression plasmid pcDNA3.1-hEpo was successfully constructed and generated. Stable expression of Epo was obtained by selection of G418 after HK-2 cells were transfected. There was no obvious difference about cell growth curves between the transfected and untransfected HK-2 cells (p > 0.05). High levels of Epo expression were observed in both intra-and extraluminal culture media in the novel RAD. There was no significant difference about the inulin leak rate and the transport rate of Na + and Glu between the novel and conventional RADs (p > 0.05 for each). And the transport function of the novel and conventional RADs was significantly inhibited by ouabain and phlorizin (p < 0.01 for each). Conclusions: A novel RAD that can express Epo was successfully constructed in vitro, in which other functions of the RAD were not affected by the transfection of pcDNA3.1-hEpo.

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Albumin Loss in On-Line Hemodiafiltration

Cited by 35 publications

References 16 publications

Protein Loss in On-Line Hemofiltration

Protein Loss in On-Line Hemofiltration

Protein-Leaking Membranes for Hemodialysis

Construction of an Erythropoietin-Expressing Bioartificial Renal Tubule Assist Device

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