Biochemical mechanisms involved in blood-hemodialysis membrane interactions
- Jeffrey S Berns, MD
Jeffrey S Berns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- Professor of Medicine
- Perelman School of Medicine at the University of Pennsylvania
The contact of blood with dialysis membranes elicits an inflammatory response. A biocompatible membrane (BCM) has traditionally been defined as "one that elicits the least amount of inflammatory response in patients exposed to it" . 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 .
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 that is most important and that has been most closely studied.
COMPOSITION OF DIALYSIS MEMBRANES
Dialysis membranes can be classified into multiple groups :
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- COMPOSITION OF DIALYSIS MEMBRANES
- PERMEABILITY OF THE DIALYSIS MEMBRANE
- BLOOD-MEMBRANE INTERACTIONS
- Complement activation
- Importance of factor D
- Importance of terminal complement complex
- Contact pathway activation
- Coagulation pathway activation
- Activation of cellular components
- Thrombocytopenia and electron-beam sterilized membranes