Polymethylmethacrylate membrane with a series of serendipity.

Forty years have passed since the polymethylmethacrylate (PMMA) membrane was first developed. This article reviews its history and explains its longevity. The membrane was developed through application of a stereocomplex phenomenon that is observed upon mixture of isotactic and syndiotactic PMMA polymers. Filtryzer(TM) B1 and B2 were approved in Japan in 1977. B1 was the pioneer high-performance membrane model and B2 was a model that simulated a low-flux cellulosic membrane. The development of B1 led to the development of the dialysis machine with an ultrafiltration rate (UFR)-controlling function because the UFR of B1 was too high to control using transmembrane pressure control. B1 was used not only as a dialyzer but also as a hemodiafilter by combination with a UFR controller. Biocompatibility of the dialysis membrane, complement activation and/or transient leukopenia was studied with B2. Cooperative studies between Niigata University and Toray resulted in Gejyo's finding regarding the harmfulness of β(2)-microglobulin (BMG). Long-term follow-up of patients dialyzed using the BK membrane revealed that plasma BMG levels were significantly low and that the occurrence ratio of carpal tunnel syndrome was suppressed. These results were obtained by the adsorptive removal of BMG onto a PMMA membrane. Several papers have discussed new aspects in succession mainly based on clinical experiences that were not aimed at a development stage, i.e. they were kinds of serendipity. For the BK-F membrane with the largest pore size, this includes anemia and removal or modification of furancarboxylic acid, homocysteine, pentosidine and soluble CD40. For the BG membrane with a slightly anionic component, this includes pruritus and removal of free immunoglobulin light chains. Even patients' prognoses may be modified by the use of PMMA membrane. The mechanisms of these findings have been clarified bit by bit and the membrane will further open new frontiers in dialysis treatment.