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Biochemical mechanisms involved in blood-hemodialysis membrane interactions

Author
Jeffrey S Berns, MD
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD

INTRODUCTION

The contact of blood with dialysis membranes elicits an organized inflammatory response that involves the activation of the body's defense against "non-self." A biocompatible membrane (BCM) has traditionally been defined as "one that elicits the least amount of inflammatory response in patients exposed to it" [1]. It has been suggested, however, that "adsorption" (ie, binding) of low molecular weight proteins or peptides on certain types of dialysis membranes represents an additional mechanism of clearance during dialysis and may also be important in defining the biocompatibility of the membrane [2].

This topic will review the pathways activated during the interaction of blood with biomaterials and the contribution of adsorption to modifying the inflammatory response resulting from this interaction. The known interactions between blood and the new hemodialysis membranes will be emphasized, with only limited attention to the effect of reuse. Because hemodialysis is a repetitive procedure, minor reactions induced by the membrane at each treatment can eventually lead to adverse long-term clinical sequelae. The acute and chronic clinical sequelae of blood-membrane interactions are discussed separately. (See "Reactions to the hemodialysis membrane" and "Clinical consequences of hemodialysis membrane biocompatibility".)

In the broadest sense, all aspects of the dialysis treatment affect biocompatibility. These include dialysate composition and temperature, the permeability/porosity of the dialysis membrane, the type of clearance (diffuse or convective), the initial sterilant (eg, ethylene oxide), reuse procedure and sterilant (formaldehyde, hypochlorite, peroxyacetic acid/hydrogen peroxide), and residual materials from the manufacturing process. However, it is the biocompatibility of the membrane itself which is most important and which has been most closely studied.

COMPOSITION OF DIALYSIS MEMBRANES

Dialysis membranes can be classified into multiple groups [3]:

Cellulosic

          

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Literature review current through: Nov 2016. | This topic last updated: Fri Jan 23 00:00:00 GMT 2015.
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