Title:
OPTIMUM SIEVING AND BIOCOMPATIBILITY PROFILES OF THE NEW HIGH-FLUX DIALYSIS MEMBRANE PUREMA® H

Detlef H. Krieter¹ ;Detlef H. Krieter¹ ;Detlef H. Krieter² ;Detlef H. Krieter³ ;Detlef H. Krieter¹

University of Würzburg ; 2. Dialysis Center Elsenfeld Germany' ne ''

E-mail address corresponding author:
krieter_d@medizin.uni-wuerzburg.de

Background:
Optimizing sieving and biocompatibility profiles, which may contribute to more adequate dialysis therapy, is the major goal of dialysis membrane engineering.

Methods:
In a prospective cross-over study on 8 ESRD patients (mean age 65 ± 15 years; f/m: 5/3), the newly developed polyethersulfone high-flux membrane PUREMA® H (Membrana GmbH, 1.7 m2; refers as PH) was compared to high-flux polysulfone (Helixone®, Fresenius FX80, 1.8 m2; refers as FX) in respect to small and middle molecular solute removal and biocompatibility. Solute removal was determined by instantaneous clearances, removal rates (RR), and mass transfer into continuously collected dialysate. Biocompatibility was characterized by white blood count, C5a and thrombin-antithrombin III (TAT) measurements. Treatment time was identical for individual patients during dialysis with PH and FX (236 ± 11 min). Blood and dialysate flow rates were set at 300 and 500 ml/min, respectively). A paired Student’s t-test was performed for statistical analysis.

Results:
Urea/creatinine/phosphate clearances after 30 min of treatment were similar for both dialyzers (PH 255 ± 9/250 ± 9/259 ± 8 mL/min; FX 256 ± 4/249 ± 4/259 ± 4 mL/min) whereas middle molecular (b2m (11.8 kDa)/cystatin c (13.4 kDa)/myoglobin (17.8 kDa)) clearances (PH 120 ± 15*/116 ± 13*/52 ± 17* mL/min; FX80 98 ± 9/74 ± 8/15 ± 11 mL/min; *p<0.001) and RR (PH 72 ± 5*/70 ± 5*/52 ± 7* % vs. FX 66 ± 6/56 ± 10/23 ± 10 %; *p<0.001) were significantly higher for PH as compared to FX. Albumin loss into the dialysate was low for both, polyethersulfone and polysulfone, membranes (PH 531 ± 171* mg vs. FX <218 ± 10 mg; *p<0.01). The leukocyte nadir occurred earlier with PH (at 5 min) than with FX (at 10 min) being 92 ± 13 % and 82 ± 8 %, respectively (p=0.075). C5a generation at 5 min was significantly lower for PH (1.1 ± 1* µg/L vs. FX 2.9 ± 2.3 µg/L; *p=0.049). TAT generation reached comparable levels at the end of dialysis (PH 2.1 ± 0.3 to 5.9 ± 7.8 µg/L vs. FX 2.3 ± 0.4 to 6.6 ± 6.3 µg/L).

Conclusion:
The data show that the new polyethersulfone membrane PUREMA® H is characterized by higher middle molecular clearances at low albumin loss, an excellent biocompatibility and a steeper sieving profile than the polysulfone membrane Helixone®. Therefore, new membranes, such as PUREMA® H, are still able to improve the standards in high-flux hemodialysis, which may contribute to better treatment adequacy in ESRD.

Subject:
Hemodialysis

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