Protein-leaking membranes for hemodialysis: a new class of membranes in search of an application?
A new class of membranes that leak protein has been developed for hemodialysis. These membranes provide greater clearances of low molecular weight proteins and small protein-bound solutes than do conventional high-flux dialysis membranes but at the cost of some albumin loss into the dialysate. Protein-leaking membranes have been used in a small number of clinical trials. The results of these trials suggest that protein-leaking membranes improve anemia correction, decrease plasma total homocysteine concentrations, and reduce plasma concentrations of glycosylated and oxidized proteins. However, it is not clear yet that routine use of protein-leaking membranes is warranted. Specific uremic toxins that are removed by protein-leaking membranes but not conventional high-flux membranes have not been identified. It is also unclear whether protein-leaking membranes offer benefits beyond those obtained with conventional high-flux membranes used in convective therapies, such as hemofiltration and hemodiafiltration. Finally, the amount of albumin loss that can be tolerated by hemodialysis patients in a long-term therapy has yet to be determined. Protein-leaking membranes offer a new approach to improving outcomes in hemodialysis, but whether their benefits will outweigh their disadvantages will require more basic and clinical research.
Ward
Richard A
RA
Kidney Disease Program, Department of Medicine, University of Louisville, 615 S. Preston Street, Louisville, KY 40202-1718, USA. richard.ward@kdp.louisville.edu
D000418:Albumins / Q000378:metabolism; D000740:Anemia / Q000628:therapy; D002986:Clinical Trials as Topic; D015314:Dialysis Solutions; D006031:Glycosylation; D017583:Hemodiafiltration; D006710:Homocysteine / Q000737:chemistry; D006801:Humans; D020138:Hyperhomocysteinemia / Q000628:therapy; D007674:Kidney Diseases / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000628:therapy; D008567:Membranes, Artificial; D008970:Molecular Weight; D010100:Oxygen / Q000737:chemistry / Q000378:metabolism; D011506:Proteins / Q000737:chemistry; D006435:Renal Dialysis / Q000295:instrumentation* / Q000379:methods*; D013997:Time Factors
D000418:Albumins; D015314:Dialysis Solutions; D008567:Membranes, Artificial; D011506:Proteins; D006710:Homocysteine; D010100:Oxygen