¹Departments of Nephrology, Nuclear Medicine, and Immunohematology, St. Bortolo Hospital, Vicenza, Italy

Correspondence: Dr Claudio Ronco, Department of Nephrology, St. Bortolo Hospital, 36100 Vicenza, Italy.

Received 5 August 1991; Revised 12 November 1991; Accepted 14 November 1991.

Abstract

A new scintigraphic method to characterize ultrafiltration in hollow fiber dialyzers. Ultrafiltration and pressure profiles in hollow fiber dialyzers with different hydraulic permeabilities have been investigated with a new scintigraphic method. Radiolabelled albumin macroaggre-gates, used as a nondiffusible marker molecule, were added to the blood in an in vitro circuit and circulated through cuprophan and polysulphon dialyzers. Since the marker molecule was too big to cross the dialysis membrane, its changes in concentration were assumed to occur in response to the variation of the blood water content (filtration or backfiltration). These changes in concentration, recorded by a gamma camera, were evaluated to establish the cumulative values of filtration and backfiltration and their relevant profiles along the length of the dialyzer. The achieved data were compared with the experimental values of ultrafiltration empirically measured and with the theoretical values predicted by a classic linear method. Two conditions were analyzed: A) the minimal filtration rate necessary to avoid backfiltration (critical filtration); and B) the condition of zero net filtration in which filtration equals backfiltration. The nuclear method proved to be extremely precise in predicting the ultrafiltration values and significantly more precise than the linear method, especially for the highly permeable dialyzer. The reason for that probably depends on the non-linear pressure and ultrafiltration profile observed with the scintigraphic pattern of the dialyzer. Viscosity changes and local variations in blood flow may in fact interfere with the pressure drop inside the hollow fibers and result in such a complex behavior. The other interesting aspect of this method is the possibility of accurate measurement of the amount of backfiltration that wouldn't be possible with simple calculations. In conclusion, the complex nature of the phenomena regulating the water fluxes in hollow fiber dialyzers requires more complex calculation than a simple linear model to achieve an accurate range of predictability.