Multipotentials of new asymmetric cellulose triacetate membrane for on-line hemodiafiltration both in postdilution and predilution

Renal Replacement Therapy

Daisuke Hirose¹  Yusaku Tanaka¹  Hiroyuki Michiwaki¹  Hirofumi Asa¹  Tomohiro Tao¹  Jun Minakuchi² 

[1] Clinical Engineering Department, Social Medicine Corporation Kawashima Association, Kawashima Hospital, 1-1-39, Kitasako, 770-0011, Tokushima City, Tokushima Prefecture, Japan;Kidney Internal Medicine (Dialysis, Renal Transplantation), Tokushima, Japan;

关键词: On-line hemodiafiltration;    Asymmetric cellulose triacetate;    β-microglobulin;    α-microglobulin;    Albumin leakage;   

DOI  :  10.1186/s41100-019-0215-x

来源: publisher

【 摘 要 】

BackgroundOn-line hemodiafiltration (OL-HDF) has been generally provided mainly by the postdilution method in Europe and the rest of the world; however, in Japan, it has been provided mostly by the predilution method in order to ameliorate dialysis-related symptoms of dialysis patients by removing larger low molecular weight proteins. This study aimed to elucidate the removal properties of a newly launched asymmetric triacetate (ATA) membrane in OL-HDF both in the postdilution and predilution comparison with other synthetic polymer membranes.MethodsSix patients treated by OL-HDF at the Kawashima Hospital Group were randomly chosen for each membrane study. The removal properties of low molecular weight proteins were evaluated by β2-microglobulin (β2-MG), α1-microglobulin (α1-MG), albumin leakage, selective removal index of α1-MG for albumin, and transmembrane pressure for each treatment group. Two types of ATA membrane were evaluated in the study: FIX-S with mild protein permeability and FIX-U with higher protein permeability in the comparisons with other three types of synthetic polymer membranes.ResultsThe removal rate of β2-MG showed almost no significant differences between the postdilution and predilution methods in most membrane groups at around 75–80% without relations to the membrane material and the substitution volume.The removal rates of α1-MG were markedly different depending on the dilution method of HDF, the membranes, and the substitution volume. Generally, the removal rates of α1-MG were better in the postdilution than the predilution but the selective removals of α1-MG were better in the predilution. The high volume OL-HDF had the risk of excessive albumin leakage in a certain membrane choice.In the FIX series, the removal rates of α1-MG were sufficient both in the postdilution and predilution with the increase of the substitution volume with suppressing the albumin leakage during the dialysis session. Especially, FIX-U showed higher removal of α1-MG with suppressing the albumin leakage.ConclusionsThe newly launched ATA membrane could remove α1-MG, selectively suppressing the excessive albumin leakage and increasing the substitution volume safely even in high-volume postdilution.Trial registrationTrial registration: University hospital Medical Information Network (UMIN), UMIN 000035705. Registered 28 January 2019 - Retrospectively registered, https://www.umin.ac.jp/ctr/index-j.htm.

【 授权许可】

CC BY