Optimal Design of Dialyzers.

BACKGROUND: Several types of synthetic dialysis membranes, including polysulfone, polyethersulfone, and polyester polymer alloy membranes, have asymmetrical structures. Dialyzers with these membranes show higher water and solute transport performance because the actual membrane thickness, which is related to the water and solute transfer resistance, is quite small compared with that in membranes with a homogeneous structure.

SUMMARY: The performance of a dialyzer depends not only on membrane permeability to water and solutes, but also on flow conditions of the blood and dialysate, which are determined during dialyzer fabrication. Many types of high-flux dialyzers with high-performance membranes have a high internal filtration/backfiltration (IF/BF) flow rate. In the enhanced IF/BF dialyzer, membrane fouling occurs more readily than with the conventional dialyzer because of the high local transmembrane pressure needed to enhance the IF/BF flow rate. To select the optimal enhanced IF/BF dialyzer for individual patients, we need to balance the disadvantage of membrane fouling with the advantage of increased convective transport. Key Messages: The following principles should guide dialyzer development in the near term. (1) Dialyzers should show high performance for the removal of low-molecular-weight proteins related to certain complications under conditions of low albumin and amino acid loss. (2) Dialyzers with biocompatible membranes are required to prevent severe adverse reactions, even though the causal relationship between these reactions and some complications remains to be clarified.