The changing face of dialyzer membranes and dialyzers.

IF 1.4 4区 医学 Q3 UROLOGY & NEPHROLOGY
Andrew Davenport
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引用次数: 0

Abstract

The key goals for dialysis treatments are to prevent the progressive accumulation of waste products of metabolism and volume overload. Traditionally uremic solutes have been classified according to molecular weight and termed small, middle sized, and large solutes. Solute clearance during dialysis sessions will potentially be by diffusion, convection and adsorption. Dialyzer membranes act as a semi-permeable membrane restricting solute removal predominantly by size. Small molecules move faster than large molecules, so small solutes are readily removed by diffusion. Increasing the size of the pores in the membrane will potentially allow middle and larger sized solutes to pass through the dialyzer membrane, although in practice there is a limit to increasing pore sizes to prevent the loss of albumin and other important proteins. Differences in membrane surface and charge will influence protein absorption. The removal of fluid during dialysis depends in part on the hydraulic permeability of the membrane. Combining higher hydraulic permeability and larger sized pores increases convective clearance with solutes moving across the membrane with the water movement. Depending upon dialyzer design, higher hydrostatic pressure as blood enters the dialyzer leads to a variable amount of internal diafiltration, so improving the clearance of middle sized solutes. Although the dialyzer membrane plays a key role in solute clearance, the design of the casing and header also play a role in directing the countercurrent blood and dialysate flows to maximize the surface area available for diffusive and convective clearances.

透析器膜和透析器的变化。
透析治疗的关键目标是防止代谢废物的逐渐积累和容量过载。传统上,尿毒症溶质按分子量分类,分为小溶质、中溶质和大溶质。在透析过程中溶质清除可能是通过扩散、对流和吸附。透析器膜作为一种半透膜,主要通过尺寸限制溶质的去除。小分子比大分子运动得快,所以小的溶质很容易通过扩散去除。增加膜上孔隙的大小可能会允许中等和较大尺寸的溶质通过透析器膜,尽管在实践中,增加孔隙大小是有限制的,以防止白蛋白和其他重要蛋白质的损失。膜表面和电荷的差异会影响蛋白质的吸收。透析过程中液体的去除部分取决于膜的水力渗透性。结合更高的水力渗透率和更大尺寸的孔隙,增加了溶质随着水的运动在膜上移动的对流间隙。根据透析器的设计,当血液进入透析器时,较高的静水压力会导致不同数量的内部滤过,从而提高中等溶质的清除率。虽然透析器膜在溶质间隙中起着关键作用,但套管和封头的设计也在引导逆流血液和透析液流动方面发挥作用,以最大限度地提高扩散和对流间隙的可用表面积。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Seminars in Dialysis
Seminars in Dialysis 医学-泌尿学与肾脏学
CiteScore
3.00
自引率
6.20%
发文量
91
审稿时长
4-8 weeks
期刊介绍: Seminars in Dialysis is a bimonthly publication focusing exclusively on cutting-edge clinical aspects of dialysis therapy. Besides publishing papers by the most respected names in the field of dialysis, the Journal has unique useful features, all designed to keep you current: -Fellows Forum -Dialysis rounds -Editorials -Opinions -Briefly noted -Summary and Comment -Guest Edited Issues -Special Articles Virtually everything you read in Seminars in Dialysis is written or solicited by the editors after choosing the most effective of nine different editorial styles and formats. They know that facts, speculations, ''how-to-do-it'' information, opinions, and news reports all play important roles in your education and the patient care you provide. Alternate issues of the journal are guest edited and focus on a single clinical topic in dialysis.
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