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A renal replacement therapy (RRT) membrane is a semi-permeable filter with pores of approximately 35,000 Da. A logarithmic linear relationship exists between molecular weight (MW) cut-off and membrane pore size. A 1 kDa MW cut-off corresponds to about 1.3 nm in membrane pore size, whereas a 10 kDa membrane has a pore size of about 2.9 nm. Along this membrane, the diffusion and convection processes can take place. Diffusion follows a concentration gradient [as in intermittent hemodialysis (IHD)] and is the ideal method to remove small (< 500 Da) molecules such as creatinine. Convection follows a hydrostatic pressure gradient [as in continuous veno-venous hemofiltration (CVVH)] and is the best method to remove middle-large (between 500 Da and 60 kDa, such as the 13,750 Da beta-2 microglobulin) and large molecules (between 60 to 100kDa, such as the 70 kDa albumin). The theoretical cut-off is 35 kDa (so only low-middle molecules will pass the membrane when using convection). When diffusion and convection are used simultaneously in continuous mode, this is called continuous veno-venous hemodiafiltration (CVVHDF).[1]

What a clinician should know about a renal replacement membrane?