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Muriel P. C. Grooteman, Menso J. Nubé, Impact of the type of dialyser on the clinical outcome in chronic haemodialysis patients: does it really matter?, Nephrology Dialysis Transplantation, Volume 19, Issue 12, December 2004, Pages 2965–2970, https://doi.org/10.1093/ndt/gfh502
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Introduction
Despite the relative efficiency of modern equipment, haemodialysis (HD) remains inferior to normal kidney function for several reasons. First of all, HD treatment results in a weekly clearance of small molecular weight substances of only 10–15 ml/min, as compared with 90–120 ml/min for normal kidneys. Secondly, so-called ‘middle molecules’ (MMs) as well as some larger peptides, which are normally excreted or metabolized by the healthy kidney, are cleared inadequately and will therefore accumulate in chronic HD (CHD) patients. Thirdly, various undesirable interactions, including both short- and long-term side effects—termed bio(in)compatibility—may occur between the living organism and the extracorporeal circuit (ECC) [1].
In the last decades, a variety of new dialysers, differing in design, material, membrane surface area and permeability, have been developed. Very recently, one of the world's largest companies involved in the production and development of dialysers replaced its total set of low-flux (LF) dialysers by a new one with better urea clearances and higher ultrafiltration (UF) coefficients. Actually, these new devices do not fulfil the criteria for LF (UF <10 ml/mmHg/h), but must be considered medium flux (UF 10–20 ml/mmHg/h). However, today there is no general agreement as to whether the use of dialysers with an increased urea removal and/or a higher UF rate is associated with a better clinical course. In fact, cardiovascular disease (CVD) is already observed in the pre-dialysis phase and is the major cause of death in end-stage renal disease (ESRD) [2]. Dialysis patients suffer from atherosclerotic complications at a relatively young age and die relatively young from ischaemic heart disease [3]. Therefore, it is conceivable that individual patient factors, such as the burden of CVD, greatly surpass the influence of the dialysis equipment in this respect. In this review, we will first discuss various aspects of the dialyser which have been associated with the clinical outcome in CHD patients. Besides the type of membrane, various aspects of bio(in)compatibility and solute mass transport are discussed. Thereafter, we will summarize the influence of the type of dialyser on a number of indirect parameters for CVD, including several biochemical and functional tests. Finally, we will review critically the relevant literature to determine whether the choice of the dialyser contributes to the life expectancy of patients with ESRD.
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