The Dialyzer Identification Code (DIC): A filter characteristics codification for dialyzer choice in renal replacement therapy

Abstract

The dialyzer is the core element of extracorporeal blood purification therapies where several processes take place depending on specific membrane characteristics. To date, the filter choice requires preliminary knowledge of all its characteristics as they cannot be easily deduced from the commercial trade name, hence the difficulty in identifying easily equivalent dialyzers and clearly comparing single‐filter characteristics. The choice of improper dialyzers for a specific treatment can determine a less‐effective blood purification and potentially harmful treatments. We aimed to propose a univocal and standardized alphanumeric string to summarize essential filter properties in the Dialyzer Identification Code (DIC). DIC clearly describes device characteristics and allows to compare different dialyzer performances without resorting to the technical data sheets. Therefore, the presence of the DIC on every device facilitates information retrieval on the dialyzer, its intended use, and can facilitate matching the dialysis modality to correct dialyzers achieving a personalized renal replacement therapy. The standard filter characteristics codification by the DIC may further optimize correct extracorporeal blood purification prescriptions and the use of equivalent filters from different providers avoiding treatment inefficiency, clinical complications, and improving patient safety.

Time‐resolving characterization of molecular weight retention changes among three synthetic high‐flux dialyzers

“…As sieving coefficient measurements are required by the respective dialyzer standards, also the results from such time‐resolving measurements would be generally comparable between different laboratories. Nalesso et al 23 recently suggested to standardize dialyzer descriptions and to include molecular weight cut‐off and retention onset, which is generally missing in the current dialyzer instruction for use. Our present approach could help to close this gap and may be easier to implement than other measurements, such as dextran measurements, as here special equipment would be necessary, and the standardization would be more complex.…”

“…We investigated the three dialyzers FX CorAL (Fresenius Medical Care), ELISIO (Nipro), and xevonta (B. Braun) used in the clinical study comPERFORM ( Com parative Clinical Perform ance of Dialyzers Applied During High Volume Online Hemodiafiltration, NCT04102280) 22 . Table 1 summarizes information for dialyzers according to Nalesso et al, 23 for the following categories: Membrane/Area, Coefficients, Clearances, Sieving Coefficients, and Modality. For the categories SC‐MW (molecular weight retention onset and molecular weight cut‐off) and RR (middle and high molecular weight reduction rate) the manufacturers provide no information in the respective instructions for use or brochures.…”

The patient safety in extracorporeal blood purification treatments of critical patients

“…Specifically, errors in the parameters of the EBPT prescription relate to incorrect nomenclature ( 17 , 18 ), blood flow, dialysate flow, total reinfusion flow, unit of measurement of flows, pre- and post-dilution reinfusion percentage, filtration fraction (FF), inappropriate weight loss ( 19 ), anticoagulation settings (citrate, heparin, and low–molecular weight heparin dose) composition of hemodiafiltration bags, and, finally, the discrepancy between prescribed and administered dose that depends on real patient’s weight, dilution factor, and treatment downtime ( Table 1 ). The use of incorrect materials relates to the wrong association between the blood purification technique and the filter characteristics depending on its intended use ( 20 ), and between patient’s acid–base and electrolytic balance and the hemodiafiltration fluid composition ( 14 ). These errors lead to an incorrect formulation of the treatment with possible iatrogenic damage to the patient (for example, electrolytes alterations).…”