Medium Cut-Off Membranes - Closer to the Natural Kidney Removal Function

Zweigart, Carina; Boschetti‐de‐Fierro, Adriana; Hulko, Michael; Nilsson, Lars‐Göran; Beck, Werner; Storr, Markus; Krause, Bernd

doi:10.5301/ijao.5000603

Cited by 44 publications

(48 citation statements)

References 51 publications

(61 reference statements)

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“…Only recently, new spinning technology allowed creation of membranes with larger pores and a narrow pore size distribution. One target was to create membranes with the sieving coefficients closer to those of the natural kidney . Not unexpectedly, these membranes were at first tested in ESRD patients and with intermittent hemodialysis or hemodiafiltration, and data on intensive care patients is still scarce.…”

Section: Discussionmentioning

confidence: 99%

Super High‐Flux Continuous Venovenous Hemodialysis Using Regional Citrate Anticoagulation: Long‐Term Stability of Middle Molecule Clearance

et al. 2018

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Continuous renal replacement therapy is a standard treatment in critically ill patients with acute kidney injury. All CRRT techniques provide a high low-molecular weight clearance but even with hemofiltration, clearance of middle molecules is low. We investigated whether a new super high-flux hemofilter provides effective and sustained middle molecule clearance during citrate-anticoagulated continuous venovenous hemodialysis for up to 72 h. We included 14 critically ill patients with AKI-KDIGO-III in a prospective observational trial. We measured/calculated blood and urine concentrations, clearances and sieving coefficients of eight molecules with molecular weights from 60 to 66 kDa, hemodynamic parameters and SAPS-II scores. All filters were patent at 72 h. Clearance and sieving coefficients of small solutes were high and sustained over time, those for larger solutes decreased over 72 h but remained high enough to decrease blood concentrations of solutes up to 25 kDa. Albumin serum levels remained unaffected. Catecholamine doses and SAPS-II scores decreased significantly. This new hemofilter may improve blood purification in critically ill patients with AKI.

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Section: Discussionmentioning

confidence: 99%

Super High‐Flux Continuous Venovenous Hemodialysis Using Regional Citrate Anticoagulation: Long‐Term Stability of Middle Molecule Clearance

et al. 2018

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“…The HRO class is the newest generation of highly selective and permeable membranes for the treatment of ESRD patients undergoing extracorporeal therapy [24,25] . Innovations in manufacturing technology have allowed the develop- Fig.…”

Section: Discussionmentioning

confidence: 99%

Modeling of Internal Filtration in Theranova Hemodialyzers

Lorenzin

Neri

Clark

et al. 2017

Expanded Hemodialysis: Innovative Clinical Approach in Dialysis

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High retention onset (HRO) is the designation for a new class of hemodialysis membranes. A unique characteristic of this class is the highly selective and controlled porosity resulting in sieving properties that provide a clinically desirable balance between middle/large molecular weight solute removal and albumin loss. Another defining feature of this membrane class is the relatively small fiber diameter, which produces high convective volumes in the form of internal filtration. The aim of the present study was to estimate, by semiempirical methods, convective volumes for 2 new HRO dialyzers: Theranova 400 and Theranova 500 (Baxter International Inc., Deerfield, IL, USA). Axial blood and dialysate compartment pressure drop along with transmembrane pressure, measured in vitro with blood ( Q b = 300 or 400 mL/min; Q d = 500 mL/min; net ultrafiltration rate = 0), served as input parameters for 3 different models: linear, geometric, and (non-linear) mathematical. Based on the most rigorous mathematical model, the estimated convective volumes were 1,661 mL/h ( Q b = 300 mL/min) and 1,911 mL/h ( Q b = 400 mL/min) for Theranova 400 and 1,864 mL/h ( Q b = 300 mL/min) and 1,978 mL/h ( Q b = 400 mL/min) for Theranova 500. These results suggest that the unique fiber characteristics of this new class of membranes provide substantial convective volumes without the need for exogenous substitution fluid. As such, HRO membranes are a major end-stage renal disease treatment advance in the quest to enhance the removal of larger-sized uremic toxins.

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“…Currently, hemodiafiltration blood purification membranes are recommended to be more efficient in comparison with high-flux dialysis due to less intradialytic hypotension and less nutrient loss [40]. Cutoff adjustment of new MCO membranes is due to advances in membrane manufacturing technologies (high-tech fabrication equipment, improved packing densities, enhanced spinning techniques, fiber undulation, decreased internal filtration as a result of fiber diameter control) [41]. MCOs have permeability values between protein-leaking dialyzers and high cutoff membranes with ß 2 -microglobulin and albumin sieving coefficients equal to 1.0 and 0.2, respectively [41].…”

Section: Current Progress In Hemodialysis Membranes Technology 61 MImentioning

confidence: 99%

“…Cutoff adjustment of new MCO membranes is due to advances in membrane manufacturing technologies (high-tech fabrication equipment, improved packing densities, enhanced spinning techniques, fiber undulation, decreased internal filtration as a result of fiber diameter control) [41]. MCOs have permeability values between protein-leaking dialyzers and high cutoff membranes with ß 2 -microglobulin and albumin sieving coefficients equal to 1.0 and 0.2, respectively [41]. Accordingly, efficient middle toxin removal would also not solve the hemodialysis-related complications, and the solution to this problem should be found in compatibility of the membrane materials.…”

Section: Current Progress In Hemodialysis Membranes Technology 61 MImentioning

confidence: 99%

Challenges and Advances in Hemodialysis Membranes

Mollahosseini¹,

Abdelrasoul²,

Shoker³

2020

Advances in Membrane Technologies

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Hemodialysis (HD) is a filtration vital process through which the bloods' toxins and contaminations are removed. However, several immune system activations occur during dialysis, which can result in morbidity and mortality. The efficiency of the currently available blood purification process is hindered, on one hand, by the deficient toxins and middle molecule removal, and on the other hand, with the loss of valuable blood components (such as plasma and its constituents). This chapter offers an overview of the challenges and advances in HD membranes. It includes an introduction of the end stage renal disease, concepts of dialysis, its historical background, and the path through which the configurations and materials evolved. The interactions between membrane polymeric materials with human blood is also discussed. The aspect of material modification is one of the critical areas in HD technology as it targets to solve the most immediate and prevalent HD issue of membrane bioincompatibility. High flux dialysis (HFD) and hemofiltration (HF) are introduced and discussed. This class of membranes was introduced to solve middle molecule (such as β2-microglobulin) related challenges. This chapter highlights the question of why the issue of incompatible materials still exists along with current membrane modifications.

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Medium Cut-Off Membranes - Closer to the Natural Kidney Removal Function

Cited by 44 publications

References 51 publications

Super High‐Flux Continuous Venovenous Hemodialysis Using Regional Citrate Anticoagulation: Long‐Term Stability of Middle Molecule Clearance

Super High‐Flux Continuous Venovenous Hemodialysis Using Regional Citrate Anticoagulation: Long‐Term Stability of Middle Molecule Clearance

Modeling of Internal Filtration in Theranova Hemodialyzers

Challenges and Advances in Hemodialysis Membranes

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