NDT Advance Access originally published online on April 27, 2007
Nephrology Dialysis Transplantation 2007 22(7):2006-2012; doi:10.1093/ndt/gfm065
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Effect of the super-flux cellulose triacetate dialyser membrane on the removal of non-protein-bound and protein-bound uraemic solutes
1Renal Division, Department of Internal Medicine, University Hospital Ghent, 2Institute of Biomedical Technology, Hydraulics Laboratory, Ghent University, Gent, Belgium and 3Department of Internal Medicine, Section of Applied Biochemistry and Nutritional Sciences, University of Perugia, Perugia, Italy
Correspondence and offprint requests to: Rita De Smet, Renal Division, Department of Internal Medicine, University Hospital, De Pintelaan 185, 9000 Gent, Belgium. Email: rita.desmet{at}Ugent.be
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Abstract |
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Background. Uraemic solutes accumulate in haemodialysis (HD) patients and interfere with physiological functions. Low-flux (LF) HD does not efficiently remove all uraemic compounds. We investigated whether large pore super-flux (SF) cellulose triacetate membranes (CTA) result in a better removal of uraemic solutes.
Methods. Eleven patients were dialysed consecutively with LF-CTA and SF-CTA during 3 weeks. Urea (UR), creatinine (CR), uric acid (UA), 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF), indole-3-acetic acid (IAA), indoxyl sulfate (IS), hippuric acid (HA), pentosidine (PENT), low-molecular weight (MW) AGEs (AGEs) and albumin were determined in pre-HD, post-HD blood and in dialysate. Reduction rate (RR), dialytic clearance and mass transfer-area coefficient (KoA) were calculated.
Results. SF-HD resulted in a higher RR than LF-HD for IS and AGEs. Urea RR correlated with HA (r = 0.59), IS (r = 0.68) and IAA (r = 0.67), (P < 0.05) for SF. Dialytic clearance ranged from 20 ± 5 to 179 ± 20 ml/min for LF and from 24 ± 6 to 191 ± 24 ml/min for SF; being higher with SF for UA, HA, IS and IAA (SF vs LF, P < 0.05). KoA was higher for most compounds with SF-HD. Albumin loss per SF session was 3.4 ± 1.3 g. The retrieved amount of uraemic solutes in dialysate with LF and SF was comparable.
Conclusions. In conventional HD, SF-CTA was superior to LF-CTA for removal of most protein-bound compounds, especially IS. Reduction rate, dialytic clearance and KoA were higher with SF. The SF-CTA membrane is albumin-leaking; however, this property could not completely explain the amount of retrieved protein-bound compounds in dialysate.
Keywords: albumin; dialysate; haemodialysis membranes; removal; uraemic toxins
Received for publication: 9. 2.06
Accepted in revised form: 19. 1.07