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Haemodialysis membranes

Abstract

Haemodialysis is an extracorporeal process in which the blood is cleansed via removal of uraemic retention products by a semipermeable membrane. Traditionally, dialysis membranes have been broadly classified on the basis of their composition (cellulosic or noncellulosic) and water permeability (low flux or high flux). However, advances in materials technology and polymer chemistry have led to the development of membranes with specific characteristics and refined properties that mandate a reconsideration of traditional membrane classification systems. For adequate characterization of these newer types of membranes, additional parameters are now relevant, including new permeability indices, the hydrophilic or hydrophobic nature of membranes, adsorption capacity and electrical potential. In this Review, we provide clinicians with an updated analysis of dialysis membranes and dialysers. We discuss the basic mechanisms that underlie solute and water removal in dialysis (that is, diffusion, convection, adsorption and ultrafiltration) in the context of treatments that use highly permeable membranes. Specifically, we highlight online haemodiafiltration and new therapies (for example, expanded haemodialysis) that utilize membranes designed to produce a high degree of internal filtration. Finally, we discuss the considerations that govern the clinically acceptable balance between large-solute clearance and albumin loss for extracorporeal therapies.

Key points

  • Traditional schemes for the classification of dialysis membranes, based simply on composition and water permeability, are outdated and new approaches are needed.

  • Dialyser utilization in clinical practice has evolved over time and is now dominated by devices with synthetic high-flux membranes.

  • Rational treatment prescription by clinicians requires an understanding of the basic mechanisms underlying solute and water removal in dialysis — namely, diffusion, convection, adsorption and ultrafiltration.

  • New therapies (including expanded haemodialysis) that utilize membranes designed to produce a high degree of internal filtration are undergoing clinical evaluation as potential alternatives to convective therapies, such as on-line haemodiafilitration.

  • The clinically acceptable amount of albumin loss for extracorporeal therapies remains to be defined.

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Fig. 1: Structural characteristics of some commercially available synthetic dialysis membranes.
Fig. 2: The manufacturing process influences both the pore size distribution and the pore density of a dialysis membrane.
Fig. 3: The physical characteristics of membranes affect their functional properties.
Fig. 4: Factors that affect diffusive and convective mass transfer.
Fig. 5: Analysis of pressure profiles in hollow-fibre haemodialysers.
Fig. 6: Performance characteristics of haemodialysis membranes derived from a suggested new classification system.

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Acknowledgements

The authors thank M. Storr (Baxter International), S. Bowry (Fresenius Medical Care), R. Baldini (B. Braun Medical), L. Fecondini (Medica), L. Frattini (Medtronic), W. Oshihara (Toray Medical), A. Simionato (Asahi Kasei Medical) and S. Takashi (Nipro Corporation) for their invaluable comments and the generous provision of membrane images. The authors recognize the seminal contributions to end-stage renal disease therapy made by L. Henderson, who passed away in 2017. He was a source of inspiration for many of us, and we owe him a debt of gratitude for his exemplary leadership in the field.

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Correspondence to William R. Clark.

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C.R. has received consultant or honoraria fees from Astute Medical, Ortho Clinical Diagnostics, Baxter International, Asahi Kasei Medical, General Electric, Jafron Biomedical, Estor Medical and Toray Medical. W.R.C. was formerly employed by Baxter International, has received consulting fees from Baxter International and owns Baxter International stock; he is also a consultant with Medtronic, Nikkiso America and Astute Medical.

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Ronco, C., Clark, W.R. Haemodialysis membranes. Nat Rev Nephrol 14, 394–410 (2018). https://doi.org/10.1038/s41581-018-0002-x

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