The role of dialyzer membrane flux in bio-incompatibility.
Dialyzer membrane flux is currently defined according to beta(2)-microglobulin (a middle molecule) clearance. Traditionally, high flux membranes were synthetic, and caused less inflammatory reaction in the extracorporeal circuit, compared with standard low-flux cuprophan bio-incompatible dialyzers. Initial reports suggested improved patient outcomes in acute renal failure when noncuprophan dialyzer membranes were used. However, over time these positive observations have not been substantiated. As the price differential between these dialyzer membrane types has become marginal, more high-flux dialyzers are now used in routine clinical practice. Two multicenter trials have recently reported a survival advantage for high-flux dialyzers. Whether this is directly consequent upon the choice of dialyzer membrane, or related to improvements in dialysate water quality, or changes in other clinical practices remains to be determined.
UCL Center for Nephrology, Royal Free and University College Medical School, Hampstead Campus, London, UK. andrew.davenport@royalfree.nhs.uk
Andrew
A
Davenport
D058186:Acute Kidney Injury / Q000628:therapy*; D001672:Biocompatible Materials; D002482:Cellulose / Q000031:analogs & derivatives*; D006023:Glycoproteins / Q000378:metabolism; D006801:Humans; D037102:Lectins / Q000378:metabolism; D008567:Membranes, Artificial; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*
D001672:Biocompatible Materials; C109662:FCN3 protein, human; D006023:Glycoproteins; D037102:Lectins; D008567:Membranes, Artificial; D002482:Cellulose; C009865:cuprammonium cellulose