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.
Kidney Disease Program, Department of Medicine, University of Louisville, 615 S. Preston Street, Louisville, KY 40202-1718, USA. richard.ward@kdp.louisville.edu
Richard A
RA
Ward
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