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Membranes
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Membranes in Renal Replacement Therapy
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Membranes in Renal Replacement Therapy

A special issue of Membranes (ISSN 2077-0375). This special issue belongs to the section "Membrane Applications".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 36049

Special Issue Editors

Prof. Dr. Chih-Ching Lin

E-Mail Website
Guest Editor
1. Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei City 11217, Taiwan
2. School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
Interests: thrombosis; arteriovenous fistula; single nucleotide polymorphism; angiotensin receptor gene; hemodialysis; chronic kidney disease
Dr. Szu-yuan Li

E-Mail Website
Guest Editor
1. Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
2. School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
Interests: molecular biology; precision medicine; epigenetics; renal replacement therapy; diabetic nephropathy

Special Issue Information

Dear Colleagues,

Renal failure is a growing health problem with high health care costs, and renal replacement therapy, also known as blood purification, removes excessive body fluid and toxic solute across a semipermeable membrane, enabling patients to live a normal life. Artificial membranes initially designed for industrial use, like ultrafiltration membrane, reverse-osmosis membrane, dialysis membrane and microfiltration membrane, almost all have their therapeutic applications. They are widely used in patients with end-stage renal disease. Currently, most dialyzers are hollow-fiber type, and the walls of the hollow fibers function as the dialysis membrane. A hollow fiber dialyzer contains a bundle of approximately 10k fibers and a surface area 1.5~2 square meters. Traditionally, dialyzers have been classified based on their water permeability (low flux or high flux) and composition (cellulosic or non-cellulosic). However, advances in materials technology have led to the development of membranes with specific characteristics and refined properties. For adequate characterization of these newer types of membranes, additional parameters, including new permeability indices, the hydrophilic or hydrophobic nature, material coating, adsorption capacity and electrical potential are now relevant. Special dialyzers have also been developed for continuous hemofiltration and sepsis patients. On the other hand, blood–membrane interaction is responsible for the activation of platelets, leukocytes, complement system and coagulation cascade in dialysis treatment, emphasizing that biocompatibility is a major concern in choosing dialysis membrane.

In this Special Issue, we aim to cover the latest developments and innovations regarding membranes in renal replacement therapy. Potential topics include, but are not limited to, the following:

  1. Landscape in hemodialysis membrane (history, present, future of hemodialysis membrane)
  2. Polymeric membrane and other various membranes used in hemodialysis
  3. Physical and chemical characteristics of continuous blood purification membrane (membranes designed for convection rather than diffusion, special design membrane for hemodynamic unstable patients)
  4. Membranes for cytokine removal in blood purification therapy (membranes with high molecular weight cut-off)
  5. Peritoneal membrane: a gift from mother nature could serve as the spare kidney
  6. Microfluidic device integrated with dialysis membrane and dialysis membrane using electrospinning technology
  7. New therapies that utilize membranes designed to produce a high degree of internal filtration as alternatives to convective therapies, such as on-line haemodiafilitration
  8. Nanotechnology in blood purification membrane

Authors are invited to submit their latest results; both original papers and reviews are welcome.

Prof. Dr. Chih-Ching Lin
Dr. Szu-yuan Li
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Membranes is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Renal replacement therapy
  • Blood purification
  • End-stage renal disease
  • Artificial kidney
  • Dialysis membrane
  • Biocompatibility

Published Papers (7 papers)

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Research

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10 pages, 1246 KiB  
Article
Perfluorooctanesulfonate Can Cause Negative Bias in Creatinine Measurement in Hemodialysis Patients Using Polysulfone Dialysis Membranes
by Wen-Sheng Liu, Chien-Hung Lin, Szu-Yuan Li, Chih-Ching Lin, Tsung-Yun Liu, Ann Charis Tan, Han-Hsing Tsou, Hsiang-Lin Chan and Yen-Ting Lai
Membranes 2022, 12(8), 778; https://doi.org/10.3390/membranes12080778 - 13 Aug 2022
Cited by 1 | Viewed by 1257
Abstract
Serum creatinine is an important clinical marker for renal clearance. However, two conventional methods (Jaffe and enzymatic) are prone to interferences with organic compounds as compared to the standard method (isotope dilution–liquid chromatography–mass spectrometry) and can cause a significant negative bias. Perfluorooctanesulfonate (PFOS) [...] Read more.
Serum creatinine is an important clinical marker for renal clearance. However, two conventional methods (Jaffe and enzymatic) are prone to interferences with organic compounds as compared to the standard method (isotope dilution–liquid chromatography–mass spectrometry) and can cause a significant negative bias. Perfluorooctanesulfonate (PFOS) and perfluorooctanoic acid (PFOA) are two common perfluorochemicals (PFCs) that can easily be accumulated in humans. We aimed to verify whether this bias is the result of an accumulation of PFCs. The serum creatinine values of 124 hemodialysis patients were analyzed using the three methods. We also aimed to evaluate which biochemical parameters will influence the difference between the conventional methods and the standard method. We found that a significant underestimation occurred when using the conventional methods. Albumin is an independent factor associated with negative bias, but it loses this correlation after dialysis, likely due to the removal of protein-bound uremic toxins. PFOS can cause negative bias when using the enzymatic method. Furthermore, this linear correlation is more significant in patients who used polysulfone-based dialysis membranes, possibly due to the better clearance of other uremic toxins. The serum creatinine of uremic patients can be significantly underestimated when using conventional methods. PFCs, as well the type of dialysis membrane being used, can be influencing factors. Full article
(This article belongs to the Special Issue Membranes in Renal Replacement Therapy)
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9 pages, 1401 KiB  
Article
Baseline Peritoneal Membrane Transport Characteristics Are Associated with Peritonitis Risk in Incident Peritoneal Dialysis Patients
by Yi-Hsin Chou, Yung-Tai Chen, Jinn-Yang Chen, Der-Cherng Tarng, Chih-Ching Lin and Szu-Yuan Li
Membranes 2022, 12(3), 276; https://doi.org/10.3390/membranes12030276 - 28 Feb 2022
Cited by 1 | Viewed by 3820
Abstract
The peritoneal equilibration test (PET) is a semi-quantitative measurement that characterizes the rate of transfer of solutes and the water transfer rate across the peritoneum in patients treated with peritoneal dialysis (PD). The results of the PET are used to maximize daily peritoneal [...] Read more.
The peritoneal equilibration test (PET) is a semi-quantitative measurement that characterizes the rate of transfer of solutes and the water transfer rate across the peritoneum in patients treated with peritoneal dialysis (PD). The results of the PET are used to maximize daily peritoneal ultrafiltration and solute clearances. Previous studies have shown that high transport status is associated with ultrafiltration failure, malnutrition, and reduced survival; however, the way in which peritoneum transport characteristics affect peritonitis risk is unknown. In the current cohort study, we recruited 898 incident-PD patients and used intention-to-treat analysis to test if baseline PET affected the subsequent 3-year peritonitis rate. Among all recruited PD patients, 308 (34.2%) developed peritonitis within three years. Multivariate Cox regression analysis showed that the high-transport group has the greatest peritonitis risk (HR 1.98, 95% CI: 1.08–3.62) even after an adjustment for demographics, comorbid diseases, and biochemical measurements. We concluded that a baseline high peritoneal membrane transport rate is an independent risk factor for peritonitis in incident PD patients. Full article
(This article belongs to the Special Issue Membranes in Renal Replacement Therapy)
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14 pages, 1029 KiB  
Article
AN69 Filter Membranes with High Ultrafiltration Rates during Continuous Venovenous Hemofiltration Reduce Mortality in Patients with Sepsis-Induced Multiorgan Dysfunction Syndrome
by Kuo-Hua Lee, Shuo-Ming Ou, Ming-Tsun Tsai, Wei-Cheng Tseng, Chih-Yu Yang, Yao-Ping Lin and Der-Cherng Tarng
Membranes 2021, 11(11), 837; https://doi.org/10.3390/membranes11110837 - 29 Oct 2021
Cited by 4 | Viewed by 2008
Abstract
Polyacrylonitrile (AN69) filter membranes adsorb cytokines during continuous venovenous hemofiltration (CVVH). Although high-volume hemofiltration has shown limited benefits, the dose-effect relationship in CVVH with AN69 membranes on severe sepsis remains undetermined. This multi-centered study enrolled 266 patients with sepsis-induced multiorgan dysfunction syndrome (MODS) [...] Read more.
Polyacrylonitrile (AN69) filter membranes adsorb cytokines during continuous venovenous hemofiltration (CVVH). Although high-volume hemofiltration has shown limited benefits, the dose-effect relationship in CVVH with AN69 membranes on severe sepsis remains undetermined. This multi-centered study enrolled 266 patients with sepsis-induced multiorgan dysfunction syndrome (MODS) who underwent CVVH with AN69 membranes between 2014 and 2015. We investigated the effects of ultrafiltration rates (UFR) on mortality. We categorized patients that were treated with UFR of 20–25 mL/kg/h as the standard UFR group (n = 124) and those that were treated with a UFR >25 mL/kg/h as the high UFR group (n = 142). Among the patient characteristics, the baseline estimated glomerular filtration rates (eGFR) <60 mL/min/1.73 m2, hemoglobin levels <10 g/dL, and a sequential organ failure assessment (SOFA) score ≥15 at CVVH initiation were independently associated with in-hospital mortality. In the subgroup analysis, for patients with SOFA scores that were ≥15, the 90-day survival rate was higher in the high UFR group than in the standard UFR group (HR 0.54, CI: 0.36–0.79, p = 0.005). We concluded that in patients with sepsis-induced MODS, SOFA scores ≥15 predicted a poor rate of survival. High UFR setting >25 mL/kg/h in CVVH with AN69 membranes may reduce the mortality risk in these high-risk patients. Full article
(This article belongs to the Special Issue Membranes in Renal Replacement Therapy)
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14 pages, 2037 KiB  
Article
Peritoneal-Membrane Characteristics and Hypervolemia Management in Peritoneal Dialysis: A Randomized Control Trial
by Szu-Yuan Li, Chiao-Lin Chuang, Chih-Ching Lin, Shin-Hung Tsai and Jinn-Yang Chen
Membranes 2021, 11(10), 768; https://doi.org/10.3390/membranes11100768 - 08 Oct 2021
Cited by 1 | Viewed by 2615
Abstract
Excessive bodily-fluid retention is the major cause of hypertension and congestive heart failure in patients with end-stage renal disease. Compared to hemodialysis, peritoneal dialysis (PD) uses the abdominal peritoneum as a semipermeable dialysis membrane, providing continuous therapy as natural kidneys, and having fewer [...] Read more.
Excessive bodily-fluid retention is the major cause of hypertension and congestive heart failure in patients with end-stage renal disease. Compared to hemodialysis, peritoneal dialysis (PD) uses the abdominal peritoneum as a semipermeable dialysis membrane, providing continuous therapy as natural kidneys, and having fewer hemodynamic changes. One major challenge of PD treatment is to determine the dry weight, especially considering that the speed of small solutes and fluid across the peritoneal membrane varies among individuals; considerable between-patient variability is expected in both solute transportation and ultrafiltration capacity. This study explores the influence of peritoneal-membrane characteristics in the hydration status in patients on PD. A randomized control trial compares the bioimpedance-assessed dry weight with clinical judgment alone. A high peritoneal membrane D/P ratio was associated with the extracellular/total body water ratio, dialysate protein loss, and poor nutritional status in patients on PD. After a six-month intervention, patients with monthly bioimpedance analysis (BIA) assistance had better fluid (−1.2 ± 0.4 vs. 0.1 ± 0.4 kg, p = 0.014) and blood-pressure (124.7 ± 2.7 vs. 136.8 ± 2.8 mmHg, p < 0.001) control; however, hydration status and blood pressure returned to the baseline after we prolonged BIA assistance to a 3-month interval. The dry-weight reduction process had no negative effect on residual renal function or peritoneal-membrane function. We concluded that peritoneal-membrane characteristics affect fluid and nutritional status in patients on PD, and BIA is a helpful objective technique for fluid assessment for PD. Full article
(This article belongs to the Special Issue Membranes in Renal Replacement Therapy)
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10 pages, 1236 KiB  
Article
The Effect of Far-Infrared Therapy on the Peritoneal Membrane Transport Characteristics of Uremic Patients Undergoing Peritoneal Dialysis: An Open-Prospective Proof-of-Concept Study
by Ching-Po Li, Chyong-Mei Chen, Chia-Hao Chan, Szu-Yuan Li, Ming-Tsun Tsai, Chun-Fan Chen, Yung-Tai Chen, Tz-Heng Chen, Fan-Yu Chen, Ching-Han Yang, Yi-Hsin Chou, Tsung-Yueh Wang, Ann Charis Tan and Chih-Ching Lin
Membranes 2021, 11(9), 669; https://doi.org/10.3390/membranes11090669 - 30 Aug 2021
Cited by 1 | Viewed by 3579
Abstract
Long-term peritoneal dialysis (PD) can lead to detrimental changes in peritoneal membrane function, which may be related to the accumulation of glucose degradation products. A previous study demonstrated that 6 months of far-infrared (FIR) therapy may decrease glucose degradation products in PD dialysate. [...] Read more.
Long-term peritoneal dialysis (PD) can lead to detrimental changes in peritoneal membrane function, which may be related to the accumulation of glucose degradation products. A previous study demonstrated that 6 months of far-infrared (FIR) therapy may decrease glucose degradation products in PD dialysate. Due to limited literature on this matter, this study aims to investigate the effect of FIR therapy on the peritoneal membrane transport characteristics of PD patients. Patients were grouped according to baseline peritoneal transport status: lower transporters (low and low-average) and higher transporters (high-average and high). Both groups underwent 40 min of FIR therapy twice daily for 1 year. In lower transporters, FIR therapy increased weekly dialysate creatinine clearance (6.91 L/wk/1.73 m2; p = 0.04) and D/P creatinine (0.05; p = 0.01). In higher transporters, FIR therapy decreased D/P creatinine (−0.05; p = 0.01) and increased D/D0 glucose (0.05; p = 0.006). Fifty percent of high transporter patients shifted to high-average status after FIR therapy. FIR therapy may decrease D/P creatinine for patients in the higher transporter group and cause high transporters to shift to high-average status, which suggests the potential of FIR therapy in improving peritoneal membrane function in PD patients. Full article
(This article belongs to the Special Issue Membranes in Renal Replacement Therapy)
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Review

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14 pages, 864 KiB  
Review
The Peritoneal Membrane—A Potential Mediator of Fibrosis and Inflammation among Heart Failure Patients on Peritoneal Dialysis
by Margarita Kunin and Pazit Beckerman
Membranes 2022, 12(3), 318; https://doi.org/10.3390/membranes12030318 - 11 Mar 2022
Cited by 3 | Viewed by 9121
Abstract
Peritoneal dialysis is a feasible, cost-effective, home-based treatment of renal replacement therapy, based on the dialytic properties of the peritoneal membrane. As compared with hemodialysis, peritoneal dialysis is cheaper, survival rate is similar, residual kidney function is better preserved, fluid and solutes are [...] Read more.
Peritoneal dialysis is a feasible, cost-effective, home-based treatment of renal replacement therapy, based on the dialytic properties of the peritoneal membrane. As compared with hemodialysis, peritoneal dialysis is cheaper, survival rate is similar, residual kidney function is better preserved, fluid and solutes are removed more gradually and continuously leading to minimal impact on hemodynamics, and risks related to a vascular access are avoided. Those features of peritoneal dialysis are useful to treat refractory congestive heart failure patients with fluid overload. It was shown that in such patients, peritoneal dialysis improves functional status and quality of life, reduces hospitalization rate, and may decrease mortality rate. High levels of serum proinflammatory cytokines and fibrosis markers, among other factors, play an important part in congestive heart failure pathogenesis and progression. We demonstrated that those levels decreased following peritoneal dialysis treatment in refractory congestive heart failure patients. The exact mechanism of beneficial effect of peritoneal dialysis in refractory congestive heart failure is currently unknown. Maintenance of fluid balance, leading to resetting of neurohumoral activation towards a more physiological condition, reduced remodeling due to the decrease in mechanical pressure on the heart, decreased inflammatory cytokine levels and oxidative stress, and a potential impact on uremic toxins could play a role in this regard. In this paper, we describe the unique characteristics of the peritoneal membrane, principals of peritoneal dialysis and its role in heart failure patients. Full article
(This article belongs to the Special Issue Membranes in Renal Replacement Therapy)
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13 pages, 2473 KiB  
Review
Influence of Dialysis Membranes on Clinical Outcomes: From History to Innovation
by Yee-An Chen, Shuo-Ming Ou and Chih-Ching Lin
Membranes 2022, 12(2), 152; https://doi.org/10.3390/membranes12020152 - 26 Jan 2022
Cited by 10 | Viewed by 12241
Abstract
Dialysis membranes were traditionally classified according to their material compositions (i.e., as cellulosic or synthetic) and on the basis of the new concept of the sieving coefficient (determined by the molecular weight retention onset and molecular weight cut-off). The advantages of synthetic polymer [...] Read more.
Dialysis membranes were traditionally classified according to their material compositions (i.e., as cellulosic or synthetic) and on the basis of the new concept of the sieving coefficient (determined by the molecular weight retention onset and molecular weight cut-off). The advantages of synthetic polymer membranes over cellulose membranes are also described on the basis of their physical, chemical, and structural properties. Innovations of dialysis membrane in recent years include the development of medium cutoff membranes; graphene oxide membranes; mixed-matrix membranes; bioartificial kidneys; and membranes modified with vitamin E, lipoic acid, and neutrophil elastase inhibitors. The current state of research on these membranes, their effects on clinical outcomes, the advantages and disadvantages of their use, and their potential for clinical use are outlined and described. Full article
(This article belongs to the Special Issue Membranes in Renal Replacement Therapy)
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