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Abstract: SA-PO553

Impact of Protein Fouling on Middle Molecule Removal During Initial Dialysis Phase

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kennedy, James Paul, Fresenius Medical Care North America, Ogden, Utah, United States
  • Emal, Karlee, Fresenius Medical Care North America, Ogden, Utah, United States
  • Werner, Joanie, Fresenius Medical Care North America, Ogden, Utah, United States
  • Ho, Chih-Hu, Fresenius Medical Care North America, Ogden, Utah, United States
  • Zawada, Adam M., Fresenius Medical Care Deutschland GmbH, Sankt Wendel, Germany
  • Boyington, Skyler, Fresenius Medical Care North America, Ogden, Utah, United States
Background

Deposition of plasma proteins to the dialyzer membrane during the initial dialysis phase strongly reduces removal capacity of middle molecules such as β2-microglobulin (β2-m). Hydrophilic membrane modification with polyvinylpyrrolidone (PVP) has been shown to reduce protein fouling and to stabilize dialyzer performance during dialysis treatment. In the present study we investigated the impact of initial protein fouling on middle molecule removal by different dialyzers, including the novel FX CorAL with PVP enriched and stabilized surface of its Helixone hydro membrane.

Methods

This in vitro study included the following dialyzers: FX CorAL 80 (Fresenius Medical Care), Revaclear 400 (Baxter), Diacap Pro 19H (B. Braun), ELISIO 17H and Cellentia 17H (both Nipro). Protein deposition to the membrane was simulated during a recirculation experiment with bovine plasma for 30 and 60 min. β2-m clearance was determined in a single-pass setup with bovine plasma at three time points (before protein fouling [0min], after 30min and 60min protein fouling). Clearance values were normalized based on the membrane surface size.

Results

Across all five investigated dialyzers, mean β2-m clearance reduced by 18.7% after 30min of plasma recirculation (0min: 35.2±9.3ml/min/m2; 30min: 28.7±7.5ml/min/m2). After additional 30min of plasma recirculation, β2-m clearance only slightly decreased (60min: 28.4±7.9ml/min/m2; -1.1% vs 30min). When comparing the clearance reduction by the different dialyzers, the FX CorAL showed low β2-m clearance decrease while having the highest β2-m clearance values throughout the experiment (0min: 47.2±3.4ml/min/m2; 30min: 39.8±0.9ml/min/m2; 60min: 40.0±1.3ml/min/m2) as compared to Revaclear (0min: p<0.001; 30min: p<0.001; 60min: p<0.001), Diacap Pro (p<0.01; p<0.001; p<0.001), ELISIO (p<0.01; p<0.001; p<0.001) and Cellentia (p<0.001; p<0.001; p<0.001).

Conclusion

Efficient removal of middle molecules while preserving vital proteins such as albumin is pivotal for patients requiring renal replacement therapy. To prevent loss of dialyzer performance during treatment, novel hydrophilic membranes, such as FX CorAL’s Helixone hydro membrane, has been shown to reduce protein fouling and to stabilize performance during treatment, especially during the initial dialysis phase.