Huang Zhongping, Gao Dayong, Letteri Jeffrey J, Clark William R
Department of Mechanical Engineering, Widener University, Chester, Pennsylvania, USA.
Semin Dial. 2009 Nov-Dec;22(6):623-8. doi: 10.1111/j.1525-139X.2009.00658.x.
In extracorporeal renal replacement therapies, the dialyzer is not only the site at which solute removal occurs but also the extracorporeal circuit component having the largest surface area exposed to blood. Therefore, it is not surprising that interactions between blood components and the dialyzer membrane influence the dialysis procedure in several ways. Based on engineering principles, fluid flow along a surface such as membrane results in the development of a boundary layer which can influence solute removal. Furthermore, the exposure of blood to any extracorporeal artificial surface results in the activation of several pathways within the body, including those involving coagulation and complement activation. One of the byproducts of this generalized activation process is protein adsorption to the membrane surface, another phenomenon which can have a significant impact on solute removal. In this article, a detailed review of the ways in which blood-membrane interactions influence solute removal during hemodialysis and related therapies is provided. The influences of secondary membrane formation and boundary layer/concentration polarization effects on solute removal are specifically discussed. Furthermore, the importance of adsorption as a specific removal mechanism for low-molecular weight proteins by highly permeable synthetic membranes is highlighted.
在体外肾脏替代治疗中，透析器不仅是溶质清除发生的场所，也是体外循环中与血液接触表面积最大的部件。因此，血液成分与透析器膜之间的相互作用以多种方式影响透析过程也就不足为奇了。根据工程原理，流体沿膜等表面流动会导致边界层的形成，而边界层会影响溶质的清除。此外，血液与任何体外人工表面的接触都会激活体内的多种途径，包括涉及凝血和补体激活的途径。这种普遍激活过程的副产物之一是蛋白质吸附到膜表面，这是另一种会对溶质清除产生重大影响的现象。本文详细综述了血液 - 膜相互作用在血液透析及相关治疗过程中影响溶质清除的方式。特别讨论了二次膜形成以及边界层/浓度极化效应对溶质清除的影响。此外，还强调了吸附作为高通透性合成膜对低分子量蛋白质的一种特定清除机制的重要性。
