Hemodialyzer Membranes and Configurations: A Historical Perspective

Clark, William R.

doi:10.1046/j.1525-139x.2000.00081.x

Cited by 24 publications

(6 citation statements)

References 8 publications

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“…11 We completed a meticulous review of the literature regarding the origins and development of the art of hemodialysis dating back several decades. 12 The nearest comparator to our observations and results is the description of the rotating drum dialyzers by Zbylut J. Twardoski in his 2008 treatise on the history of hemodialyzers' designsdthe Kolff rotating drum (1943). 13 In another related counterpoint scenario, Ponte et al 14 described, in 2007, the use of an extracorporeal membrane oxygenation (ECMO) system aided by gravitational pull through the filter of the ECMO to treat anuric postoperative acute kidney injury.…”

Section: Discussionsupporting

confidence: 58%

Timed Controlled Repeated Rotation of the CAR-170-C NXSTAGE Chronic Cartridge Hemodialysis Filter: A Novel Approach to Enabling Heparin-Free Frequent Daily Home Hemodialysis

Locke

Bushey

LaCroix

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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Heparin-free hemodialysis is often warranted in postoperative states, bleeding diathesis, and critically ill patients. Conventionally, this is achieved through normal saline flushes or regional citrate anticoagulation. An 87-year-old white man with end-stage renal disease and atrial fibrillation, who was taking warfarin and using maintenance home hemodialysis (HHD) with an NxStage machine, underwent laparoscopic appendicectomy. The procedure was complicated by intra-abdominal abscess, sepsis, and tamponade from a bloody pericardial effusion. He needed emergent therapeutic pericardiocentesis. Warfarin was promptly discontinued. He was discharged home with heparin-free HHD. Prior heparin anticoagulation for HHD was an initial bolus of 4000 units of heparin. He continued to clot his extracorporeal system with resultant very high venous pressures and compromised HHD. Heparin anticoagulation was still contraindicated. Flushes with 250-500 mL normal saline, delivered in aliquots every 15-30 minutes, failed to prevent the frequent clotting. The first author, our HD Senior Technician, had astutely observed that the horizontally placed hemodialysis filter exhibited early "clot" formation at the 12-o'clock position, despite the saline flushes. Through trial and error, he discovered that rotating the horizontally placed hemodialysis filter along its long axis, 60 degrees clockwise for 15 minutes, return to the neutral position for 15 minutes, rotating the filter another 60 degrees counterclockwise for 15 minutes, with this repeated cycle of rotations "did the trick." It promptly and consistently resolved the clotting problem. The lines stopped clotting, and he has not needed saline flushes for smooth heparin-free HHD for more than 7 months. To our knowledge, this is the first such report. Further study is justified. We have hypothesized a mechanism and have named this the "Locke-Onuigbo Maneuver."

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Section: Discussionsupporting

confidence: 58%

Timed Controlled Repeated Rotation of the CAR-170-C NXSTAGE Chronic Cartridge Hemodialysis Filter: A Novel Approach to Enabling Heparin-Free Frequent Daily Home Hemodialysis

Locke

Bushey

LaCroix

et al. 2021

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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“…Hemodialysis serves to compensate for impaired renal function in patients with end-stage renal disease. A hemodialyzer consists of a membrane that corrects the levels of blood components mainly through diffusion ( 1 – 4 ). In order to correct blood component imbalances, patients undergo hemodialysis three times weekly for 3 to 4 hours per session ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

Hemodialysis Membrane Coated with a Polymer Having a Hydrophilic Blood-Contacting Layer can Enhance Diffusional Performance

et al. 2017

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PurposeCurrently, the foreign surfaces of various extracorporeal circulation devices are coated with a biocompatible polymer coating agent (BPA), which creates a hydrophilic blood-contacting layer to reduce thrombogenicity, while the membranes in hemodialyzers are not. We aimed to clarify other side effects of BPA-coated membranes by examining the diffusion performance in in vitro experiments.MethodsWe used a polyethersulfone membrane (sieving coefficient of albumin is ≤0.01) coated with BPA product, SEC-1™ (Toyobo), in a hemodialyzer. To estimate the diffusion rates of a wide range of molecules, 2 L of saline containing vancomycin, lysozyme, and albumin were recirculated in the circuit configured with a hemodialyzer, and dialyzed continuously using water. The concentrations of sodium, vancomycin, lysozyme, and albumin were measured every 5 minutes for 30 minutes and compared in experiments with BPA-coated (n = 4) and BPA-noncoated (n = 4) membranes.ResultsThe removal rates of sodium and vancomycin after 5 minutes of dialysis (n = 24) were significantly higher in BPA-coated than noncoated membranes, while those of lysozyme and albumin were not significantly different. The removal rates of sodium and vancomycin after 30 minutes of dialysis (n = 4) were significantly higher, and those of lysozyme were significantly lower in BPA-coated than noncoated membranes, while those of albumin were not significantly different.ConclusionsThe preliminary study suggests that BPA-coated membranes enhanced the diffusion rate of molecules with low and middle molecular weight without affecting the sieving coefficient of albumin. Thus, BPA coating can enhance the dialysis performance of membranes.

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“…Therefore, by manipulating the height and width of the flat plate channel the internal resistance can be significantly reduced, negating the need for an external blood pump. These attributes popularized the flat plate hemodialyzer design 7-10 and the Kiil dialyzer dominated the market in the 1960’s 11 . However, due to deficiencies in membrane technology at the time and advantages of hollow-fiber membranes, the flat plate design was supplanted.…”

Section: Introductionmentioning

confidence: 99%

Preliminary Diffusive Clearance of Silicon Nanopore Membranes in a Parallel Plate Configuration for Renal Replacement Therapy

et al. 2016

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Silicon nanopore membranes (SNM) with compact geometry and uniform pore size distribution have demonstrated a remarkable capacity for hemofiltration. These advantages could potentially be used for hemodialysis. Here we present an initial evaluation of the SNM’s mechanical robustness, diffusive clearance, and hemocompatibility in a parallel plate configuration. Mechanical robustness of the SNM was demonstrated by exposing membranes to high flows (200ml/min) and pressures (1,448mmHg). Diffusive clearance was performed in an albumin solution and whole blood with blood and dialysate flow rates of 25ml/min. Hemocompatibility was evaluated using scanning electron microscopy and immunohistochemistry after 4-hours in an extra-corporeal porcine model. The pressure drop across the flow cell was 4.6mmHg at 200ml/min. Mechanical testing showed that SNM could withstand up to 775.7mmHg without fracture. Urea clearance did not show an appreciable decline in blood versus albumin solution. Extra-corporeal studies showed blood was successfully driven via the arterial-venous pressure differential without thrombus formation. Bare silicon showed increased cell adhesion with a 4.1 fold increase and 1.8 fold increase over polyethylene-glycol (PEG)-coated surfaces for tissue plasminogen factor (t-PA) and platelet adhesion (CD-41), respectively. These initial results warrant further design and development of a fully scaled SNM-based parallel plate dialyzer for renal replacement therapy.

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Hemodialyzer Membranes and Configurations: A Historical Perspective

Cited by 24 publications

References 8 publications

Timed Controlled Repeated Rotation of the CAR-170-C NXSTAGE Chronic Cartridge Hemodialysis Filter: A Novel Approach to Enabling Heparin-Free Frequent Daily Home Hemodialysis

Timed Controlled Repeated Rotation of the CAR-170-C NXSTAGE Chronic Cartridge Hemodialysis Filter: A Novel Approach to Enabling Heparin-Free Frequent Daily Home Hemodialysis

Hemodialysis Membrane Coated with a Polymer Having a Hydrophilic Blood-Contacting Layer can Enhance Diffusional Performance

Preliminary Diffusive Clearance of Silicon Nanopore Membranes in a Parallel Plate Configuration for Renal Replacement Therapy

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