Effect of the super-flux cellulose triacetate dialyser membrane on the removal of non-protein-bound and protein-bound uraemic solutes.
BACKGROUND
Uraemic solutes accumulate in haemodialysis (HD) patients and interfere with physiological functions. Low-flux (LF) HD does not efficiently remove all uraemic compounds. We investigated whether large pore super-flux (SF) cellulose triacetate membranes (CTA) result in a better removal of uraemic solutes.


METHODS
Eleven patients were dialysed consecutively with LF-CTA and SF-CTA during 3 weeks. Urea (UR), creatinine (CR), uric acid (UA), 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF), indole-3-acetic acid (IAA), indoxyl sulfate (IS), hippuric acid (HA), pentosidine (PENT), low-molecular weight (MW) AGEs (AGEs) and albumin were determined in pre-HD, post-HD blood and in dialysate. Reduction rate (RR), dialytic clearance and mass transfer-area coefficient (KoA) were calculated.


RESULTS
SF-HD resulted in a higher RR than LF-HD for IS and AGEs. Urea RR correlated with HA (r=0.59), IS (r=0.68) and IAA (r=0.67), (P<0.05) for SF. Dialytic clearance ranged from 20+/-5 to 179+/-20 ml/min for LF and from 24+/-6 to 191+/-24 ml/min for SF; being higher with SF for UA, HA, IS and IAA (SF vs LF, P<0.05). KoA was higher for most compounds with SF-HD. Albumin loss per SF session was 3.4+/-1.3 g. The retrieved amount of uraemic solutes in dialysate with LF and SF was comparable.


CONCLUSIONS
In conventional HD, SF-CTA was superior to LF-CTA for removal of most protein-bound compounds, especially IS. Reduction rate, dialytic clearance and KoA were higher with SF. The SF-CTA membrane is albumin-leaking; however, this property could not completely explain the amount of retrieved protein-bound compounds in dialysate.
De Smet
Rita
R
Renal Division, Department of Internal Medicine, University Hospital Ghent, Gent, Belgium. rita.desmet@Ugent.be
Dhondt
Annemieke
A
Eloot
Sunny
S
Galli
Francesco
F
Waterloos
Marie Anne
MA
Vanholder
Raymond
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002482:Cellulose / Q000031:analogs & derivatives*; D015314:Dialysis Solutions / Q000737:chemistry; D005260:Female; D006801:Humans; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D006435:Renal Dialysis / Q000295:instrumentation*; D012709:Serum Albumin / Q000032:analysis / Q000378:metabolism; D014118:Toxins, Biological / Q000032:analysis / Q000097:blood; D014511:Uremia / Q000097:blood* / Q000628:therapy*
D015314:Dialysis Solutions; D008567:Membranes, Artificial; D012709:Serum Albumin; D014118:Toxins, Biological; D002482:Cellulose; C024671:cellulose triacetate