Clark W R, Hamburger R J, Lysaght M J
Renal Division, BAxter Healthcare Corporation, McGraw Park, Illinois, USA.
Kidney Int. 1999 Dec;56(6):2005-15. doi: 10.1046/j.1523-1755.1999.00784.x.
Effect of membrane composition and structure on solute removal and biocompatibility in hemodialysis. Significant changes in extracorporeal membranes have occurred over the past five decades in which hemodialysis (HD) has been available as a therapy for both acute renal failure (ARF) and end-stage renal disease (ESRD). For cellulosic membranes, these changes have included a reduction in thickness, hydroxyl group substitution, and an increase in pore size. These modifications have resulted in enhanced efficiency of small solute removal, a broader spectrum of overall solute removal, and an attenuation of complement activation in comparison to the thick, unsubstituted cellulosic membranes of low permeability used in the early days of HD therapy. Synthetic membranes, originally developed specifically for use in high-flux HD and hemofiltration, have also evolved during this same time period. In fact, the initially clear distinction between low-flux regenerated cellulosic and high-flux synthetic membranes has become blurred, as membrane formulators have developed products designed to appeal to enthusiasts for both membrane formats. The purpose of this review is to characterize both the solute removal and biocompatibility characteristics of dialysis membranes according to their composition (that is, polymeric makeup) and structure. In this regard, the manner in which membrane biocompatibility interacts with flux is highlighted.
膜组成和结构对血液透析中溶质清除及生物相容性的影响。在过去五十年中，随着血液透析（HD）成为治疗急性肾衰竭（ARF）和终末期肾病（ESRD）的一种疗法，体外膜发生了显著变化。对于纤维素膜而言，这些变化包括厚度减小、羟基取代以及孔径增大。与HD治疗早期使用的低渗透性、未取代的厚纤维素膜相比，这些改进提高了小溶质清除效率，扩大了整体溶质清除范围，并减弱了补体激活。最初专门为高通量HD和血液滤过开发的合成膜在同一时期也得到了发展。实际上，由于膜配方师开发出了吸引两种膜类型爱好者的产品，低通量再生纤维素膜和高通量合成膜之间最初明显的区别已经变得模糊。本综述的目的是根据透析膜的组成（即聚合物构成）和结构来描述其溶质清除和生物相容性特征。在这方面，重点介绍了膜生物相容性与通量相互作用的方式。
