Albumin loss under the use of the high-performance membrane.

ABSTRACT

Beta-2-microglobulin (ß(2)M) clearance has been improved in recent dialysis membranes and minimum albumin leakage has been achieved in most membranes today since dialysis membranes are now classified by ß(2)M clearance in terms of the reimbursement by health insurance. Kawanishi et al. suggested that 'the desirable albumin leakage in one treatment is less than 4 g '. Function classification type IV or type V dialysis membranes have leakages as low as 3 g, while most resulted in < 1 g leakage. However, some high-performance membranes (HPMs) have around 8 g of leakage, which requires further study of the clinical efficacy using such dialysis membranes. The comparison of albumin leakage in one dialysis treatment (4 h blood flow volume of 250 ml/min) revealed that PES-210D has an overwhelmingly high albumin leakage of 7.69 ± 1.01 g. The data were without any significant difference between the PES-D membrane user group and the non-PES-D membrane user group for hemoglobin, hematocrit, ß(2)M protein, catabolic rate, body mass index, and muscle mass. However, the PES-D membrane user group had a significantly lower number of hospitalizations and other complication events. When comparing the event contents, the PES-D membrane user group had no cardiac failure and lower DRA, however it had more vascular access problems. In normal renal function, approximately 10 g of albumin is filtered in the glomerulus per day, decomposed in the renal tubule and reabsorbed as amino acid, and re-synthesized into albumin in the liver. On the contrary, in dialysis patients, albumin that is bound to biologically active substances and/or the oxidized form of albumin that has lost its antioxidant effect cannot be filtered from the kidney and accumulate. Therefore, the idea regarding albumin leakage is to remove biologically active substances that bind to albumin and function as uremic toxin, remove albumin without the antioxidant effect, and facilitate synthesis of new albumin with an antioxidant effect.