Hoenich N A
School of Clinical Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom.
Int J Artif Organs. 2007 Nov;30(11):964-70. doi: 10.1177/039139880703001104.
Over the past five decades, membranes used for the treatment of chronic kidney disease have continuously evolved. In the course of this evolution, the use of classical non-modified cellulose membranes has declined in favor of cellulose-based membranes in which the basic structure has been modified to improve the biocompatibility profile of the material as well as membranes based on synthetic polymers. In addition to providing improved biocompatibility, manufacturing methods have been innovatively adapted to produce membranes with optimized pore size and pore size distribution. This has led to the more effective removal of molecules involved in the development of complications associated with dialysis treatment. More recently, the approach has been move membranes beyond being just selective barriers with a high performance and to incorporate biological function. Despite these advances, membranes in current clinical use represent a compromise: while efficient in their removal of water soluble compounds, they are non selective, retain some bioreactivity and differ in their ability to adsorb endotoxins or bacterial fragments that may be present in the dialysis fluid. In this paper, an overview of the membranes used in current clinical practice and their limitations are discussed, together with approaches to solute transport in which no membranes are used.
在过去的五十年里，用于治疗慢性肾病的膜不断发展。在这一发展过程中，传统的未改性纤维素膜的使用减少，转而青睐于对基本结构进行了改性以改善材料生物相容性的纤维素基膜以及基于合成聚合物的膜。除了提供更好的生物相容性外，制造方法也进行了创新性调整，以生产具有优化孔径和孔径分布的膜。这使得参与透析治疗相关并发症发生发展的分子能够被更有效地清除。最近，这种方法已使膜不仅是具有高性能的选择性屏障，还融入了生物功能。尽管取得了这些进展，但目前临床使用的膜仍存在折衷之处：虽然它们在去除水溶性化合物方面效率很高，但它们是非选择性的，保留了一些生物反应性，并且在吸附透析液中可能存在的内毒素或细菌碎片的能力上存在差异。本文讨论了当前临床实践中使用的膜及其局限性，以及不使用膜的溶质转运方法。
