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Highly permeable membranes in dialysis: Optimal therapy design
Author(s) -
LEDEBO INGRID
Publication year - 1996
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/j.1440-1797.1996.tb00167.x
Subject(s) - ultrafiltration (renal) , membrane , dialysis , medicine , hemofiltration , chromatography , permeability (electromagnetism) , hemodialysis , chemistry , surgery , biochemistry
Summary: Considering the removal potential of diffusion and convection in relation to the size of uraemic toxins, it is evident that we should not rely solely on diffusion to purify the blood, as is the case in the most common form of dialysis, haemodialysis with low‐flux membranes. In order to remove more of the larger uraemic toxins, we need to use more convective transport in dialysis therapy. the use of high‐flux membranes is increasing and approximately 25% of all dialysis treatments are performed with these membranes. They are characterized by high permeability to water, but for good convective transport they should also have generous and stable sieving properties. the convective transport provided by these membranes when used in a haemodialysis set‐up is limited to the desired weight loss and the uncontrolled ultrafiltration which is compensated by backfiltration. to better use the potential of a high‐flux membrane, the ultrafiltration should be greatly increased, as in haemodiafiltration (HDF) and haemofiltration (HF). the large volumes of fluid, free from bacteria and pyrogen, which are required for these therapies can be provided by special multi purpose treatment systems. On‐line preparation of bicarbonate‐containing fluid that can be used for substitution is a safe, practical and cost‐effective method. In addition to high clearance of solutes over a wide molecular weight range, the convective therapies provide good haemodynamic stability in response to fluid removal during dialysis.