Nephrol Dial Transplant (2003) 18: 651-654
© 2003 European Renal Association-European Dialysis and Transplant Association
Editorial Comments
High permeability of dialysis membranes: what is the limit of albumin loss?
University of Montpellier, Lapeyronie Hospital, Department of Nephrology, Montpellier, France
Keywords: albumin loss; haemodialysis; inflammation; membrane permeability; morbidity; mortality
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Introduction
The enhanced removal of an extended spectrum of toxic low molecular weight proteins is regarded as a contribution to the improvement of dialysis adequacy. Apart from costly convective treatment modalities like haemofiltration and haemodiafiltration, the application of high-flux haemodialysis permits the elimination of far larger uraemic toxins than those removable by conventional low-flux dialysis. As a consequence, increasingly permeable high-flux dialysis membranes with excellent blood purification characteristics have been developed during the last decade, contributing to clinical benefits such as an improved erythropoietin responsiveness in renal anaemia [1,2]. However, the membrane pore size can be enlarged only within restricted limits, since together with the removal of high molecular weight toxins such as, for instance, erythropoietic inhibitors [3], essential large proteins such as albumin get lost, eventually resulting in a deficiency state.
Cross-sectional studies revealed hypoalbuminaemia to be associated with increased morbidity and mortality in
Factors influencing serum albumin in ESRD
Consequences of albumin loss across the dialyser
Beneficial effects of albumin-leaking, highly permeable dialysis membranes
Information from dialyser reuse
High membrane permeability and microinflammation
Conclusion
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