Clinical consequences of hemodialysis membrane biocompatibility
- 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
Interaction of the dialysis membrane with the components of blood has the potential to induce an inflammatory response and to lead to numerous long-term clinical sequelae that are in part determined by the degree of membrane biocompatibility. A biocompatible membrane (BCM) has traditionally been defined as "one that elicits the least amount of inflammatory response in patients exposed to it" . (See "Biochemical mechanisms involved in blood-hemodialysis membrane interactions".)
However, there is no standard technique for the measurement of biocompatibility. As a result, there are wide-ranging claims for biocompatibility by manufacturers of dialysis membranes based upon the testing method utilized, such as the generation of leukotrienes or the degree of complement activation.
Issues related to the clinical consequences of hemodialysis membrane biocompatibility are discussed in this topic review. Acute reactions to the hemodialysis membrane, such as that induced by ethylene oxide and complement activation are discussed separately. (See "Reactions to the hemodialysis membrane".)
TYPES OF HEMODIALYSIS MEMBRANES
There are three types of membranes currently used to manufacture dialyzers: cellulose, substituted cellulose, and synthetic noncellulose.
Cellulose — Cellulose, primarily manufactured as cuprophan (or cuprophane), is a polysaccharide-based membrane obtained from pressed cotton. It is composed of chains of glucosan rings with abundant free hydroxyl groups. Cupammonium is primarily used in the manufacturing process of this membrane (hence the name), but other methods of manufacturing exist.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Grooteman MP, Nubé MJ. Impact of the type of dialyser on the clinical outcome in chronic haemodialysis patients: does it really matter? Nephrol Dial Transplant 2004; 19:2965.
- Craddock PR, Fehr J, Dalmasso AP, et al. Hemodialysis leukopenia. Pulmonary vascular leukostasis resulting from complement activation by dialyzer cellophane membranes. J Clin Invest 1977; 59:879.
- Hakim RM, Breillatt J, Lazarus JM, Port FK. Complement activation and hypersensitivity reactions to dialysis membranes. N Engl J Med 1984; 311:878.
- Hornberger JC, Chernew M, Petersen J, Garber AM. A multivariate analysis of mortality and hospital admissions with high-flux dialysis. J Am Soc Nephrol 1992; 3:1227.
- Hakim RM, Held PJ, Stannard DC, et al. Effect of the dialysis membrane on mortality of chronic hemodialysis patients. Kidney Int 1996; 50:566.
- Koda Y, Nishi S, Miyazaki S, et al. Switch from conventional to high-flux membrane reduces the risk of carpal tunnel syndrome and mortality of hemodialysis patients. Kidney Int 1997; 52:1096.
- Bloembergen WE, Hakim RM, Stannard DC, et al. Relationship of dialysis membrane and cause-specific mortality. Am J Kidney Dis 1999; 33:1.
- Krane V, Krieter DH, Olschewski M, et al. Dialyzer membrane characteristics and outcome of patients with type 2 diabetes on maintenance hemodialysis. Am J Kidney Dis 2007; 49:267.
- Gutierrez A, Alvestrand A, Wahren J, Bergström J. Effect of in vivo contact between blood and dialysis membranes on protein catabolism in humans. Kidney Int 1990; 38:487.
- Lindsay RM, Spanner E, Heidenheim P, et al. PCR, Kt/V and membrane. Kidney Int Suppl 1993; 41:S268.
- Parker TF 3rd, Wingard RL, Husni L, et al. Effect of the membrane biocompatibility on nutritional parameters in chronic hemodialysis patients. Kidney Int 1996; 49:551.
- van Ypersele de Strihou C, Jadoul M, Malghem J, et al. Effect of dialysis membrane and patient's age on signs of dialysis-related amyloidosis. The Working Party on Dialysis Amyloidosis. Kidney Int 1991; 39:1012.
- Vanholder R, Ringoir S. Polymorphonuclear cell function and infection in dialysis. Kidney Int Suppl 1992; 38:S91.
- Vanholder R, Ringoir S. Infectious morbidity and defects of phagocytic function in end-stage renal disease: a review. J Am Soc Nephrol 1993; 3:1541.
- Grooteman MP, Nubé MJ. Haemodialysis-related bioincompatibility: fundamental aspects and clinical relevance. Neth J Med 1998; 52:169.
- Himmelfarb J, Zaoui P, Hakim R. Modulation of granulocyte LAM-1 and MAC-1 during dialysis--a prospective, randomized controlled trial. Kidney Int 1992; 41:388.
- Zaoui P, Green W, Hakim RM. Hemodialysis with cuprophane membrane modulates interleukin-2 receptor expression. Kidney Int 1991; 39:1020.
- Zaoui P, Hakim RM. Natural killer-cell function in hemodialysis patients: effect of the dialysis membrane. Kidney Int 1993; 43:1298.
- Himmelfarb J, Lazarus JM, Hakim R. Reactive oxygen species production by monocytes and polymorphonuclear leukocytes during dialysis. Am J Kidney Dis 1991; 17:271.
- Vanholder R, Smet RD, Glorieux G, Dhondt A. Survival of hemodialysis patients and uremic toxin removal. Artif Organs 2003; 27:218.
- Levin NW, Zasuwa GA, Dumler F. Effect of membrane types on causes of death in hemodialysis patients (abstract). J Am Soc Nephrol 1991; 2:335.
- Vanholder R, Ringoir S, Dhondt A, Hakim R. Phagocytosis in uremic and hemodialysis patients: a prospective and cross sectional study. Kidney Int 1991; 39:320.
- Thylén P, Fernvik E, Haegerstrand A, et al. Dialysis-induced serum factors inhibit adherence of monocytes and granulocytes to adult human endothelial cells. Am J Kidney Dis 1997; 29:78.
- Degiannis D, Czarnecki M, Donati D, et al. Normal T lymphocyte function in patients with end-stage renal disease hemodialyzed with 'high-flux' polysulfone membranes. Am J Nephrol 1990; 10:276.
- Hakim RM. Clinical implications of hemodialysis membrane biocompatibility. Kidney Int 1993; 44:484.
- Hakim RM, Lowrie EG. The relative effect of leukopenia and dialysate composition on the dialysis-associated hypoxemia. Proc Clin Dial Transplant Forum 1980; 10:190.
- TYPES OF HEMODIALYSIS MEMBRANES
- Substituted cellulose
- Synthetic noncellulose
- Determinants of biocompatibility
- ACUTE RENAL FAILURE
- CHRONIC RENAL FAILURE
- BETA-2 MICROGLOBULIN AND DIALYSIS-RELATED AMYLOIDOSIS
- PROTEIN CATABOLISM
- GENERAL INFLAMMATION
- LOSS OF RESIDUAL RENAL FUNCTION
- PULMONARY CHANGES