Membrane Innovation in Dialysis

Abstract

Despite advances in renal replacement therapy, the adequate removal of uremic toxins over a broad molecular weight range remains one of the unmet needs in hemodialysis. Therefore, membrane innovation is currently directed towards enhanced removal of uremic toxins and increased membrane permeability. This chapter presents a variety of opportunities where innovation is brought into dialysis membranes. It covers the membrane formation from solution, describing different approaches to control the phase inversion process through additives that either swell in the polymer solution or influence the pore shrinkage during the membrane drying process. Additionally, large-scale manufacturing is described, and the influence of raw materials, spinning, and drying processes on membrane selectivity are presented. Finally, new characterization methods developed for the latest innovations around the application of membranes in dialysis are discussed, which allow the membrane performance for removal of a broad range of uremic toxins and the expected albumin loss in clinical use. © 2017 S. Karger AG, BaselTo treat approximately 3.2 million end-stage renal disease patients with extracorporeal blood purification, approximately 320 million dialyzers are required worldwide in 2017. The number of dialysis recipients is growing by an estimated 6% annually. To fulfill current and future demands for dialyzers, large-scale manufacturing is required. The production of membranes and dialyzers requires advanced and automated manufacturing technology to fulfill the specific quality needs for medical applications and the continuously increasing demand [1] .

Understanding Development of Malnutrition in Hemodialysis Patients: A Narrative Review

“…Improvements are attributed to greater removal of middle molecules using HDF. However, these membranes and/or techniques, in addition to increasing the cost burden [ 57 , 59 , 60 , 61 , 62 ], induce greater albumin losses of 3.5 to 9.0 g per HD session [ 63 , 64 ], along with involuntary removal of vitamins, larger protein molecules, and lipids [ 62 ].…”

Exploring the Clinical Relevance of Providing Increased Removal of Large Middle Molecules

“…To enable the clearance of larger middle molecules with molecular mass between 15 and 60 kD without the loss of albumin, the distribution of the pores within the dialysis membranes had to fundamentally change to a tighter distribution ( Figure 1). The MCO dialyzers use this new distribution of pores (10). In clinical practice, these membranes should provide effective clearance of large middle molecules without excessive albumin loss.…”

A tRial Evaluating Mid Cut-Off Value Membrane Clearance of Albumin and Light Chains in HemoDialysis Patients: A Safety Device Study

“…Advancement in manufacturing technology has led to the development of a new class of dialysis membrane called the mid cut-off (MCO) dialyzer [5]. This membrane has a pore size between those of a standard high flux and an HCO membrane with narrowly distributed pores to enhance membrane permeability and selectivity.…”