Membranes and Filters
for use in Acute RRT
April 26, 2012
Modality of ARRT with Efficiency Defined
Marshall MR, Golper TA:Semin Dial 24:142-148,2011
02/04-<2>
Artificial Kidney for RRT
02/04-<3>
IHD
Hemodialyzer
CRRT
Hemofilter
PIRRT
Hemodiafilter
人工腎臟的特性
 透析膜
 材質、面積大小
 超過濾係數(UFR)與篩濾係數(SC)
 清除率
 中空纖維(Hollow Fiber)幾何結構
 膜厚度、內徑大小、長度
 消毒方法
 內毒素的阻隔能力
02/04-<4>
Categories for HD membranes
Vicken J. Membranes in Haemodialysis in；Peinemann KV, Pereira Nunes SP, (eds)
Membranes for Life Sciences. Wiley Co, 2007；1-48.
02/04-<5>
Dialyzer membranes for RRT in AKI
2012 KDIGO guideline for AKI
02/04-<6>
Agenda
Modality of ARRT
Artificial Kidney for RRT
血液透析器設計理念
血液過濾器設計理念
血液透析過濾器 for SLEDD-f
02/04-<7>
血液透析器 for IHD
Wall thickness (µm)
Inner lumen (µm)
High-flux Dialyzer
40
200
Chronic Filter
200 µm
02/04-<8>
40 µm
Agenda
Modality of ARRT
Artificial Kidney for RRT
血液透析器設計理念
血液過濾器設計理念
血液透析過濾器 for SLEDD-f
02/04-<9>
“理想的" 血液過濾（Hemofilter）
具高生物相容性
具良好的中大分子篩濾與清除效果
抗凝劑需要量越低越好
最少可連續使用24小時
02/04-<10>
“理想的" 血液過濾器
 Fuction
 Membrane permeability
– Diffusion
Low and High flux
– Convention High Hlux
 Filter and Fiber Geometry
 Adapted for low blood flow
– Large ID：short
 Biocompatibility
02/04-<11>
血液過濾器 – 中空纖維特性
Membrane geometry adapted to special needs in CRRT
Decreased wall thickness
– increased diffusive clearance
Acute Filter
Increased inner lumen
– less shear-stress
– lower thrombogenicity
– lower heparin need
Wall thickness (µm)
Inner lumen (µm)
02/04-<12>
Hemofilter
35
220
220 µm
35 µm
Agenda
Modality of ARRT
Artificial Kidney for RRT
血液透析器設計理念
血液過濾器設計理念
血液透析過濾器 for SLEDD-f
02/04-<13>
high-flux dialyser is required to SLEDD-f
A high-flux dialyser is required to perform SLEDD-f
– A dialysis membrane with high hydraulic permeability, high
solute permeability and large surface exchange
Moderate transmembrane pressures (< 300mmHg)
Simultaneously avoid or minimal albumin loss
Highly biocompatible membrane is particular importance
1,0
Sieving Coef ficient
The cut off of the membrane is ~ 30.000 Dalton.
0,8
Standard mem brane
Po lysu lf on e Ultra-Flu x
Kid n e y
0,6
0,4
0 ,2
0
100
10
Urea
Creatinine
1000
Vit.B 12
10000
Inulin
M olecular Weight [ Dalton ]
02/04-<14>
ß2-M
100000
Albumin
“Hybrid” Hospital Regimens
Extended daily (dialysis) filtration regimens at six hospitals
Extended Daily Dia-filtration
/ 5008
Mark R. Marshall
New York, USA
02/04-<15>
Hannover, Germany
Arkansas, USA
Auckland, New Zealand
/ 5008
R. Bellomo
Goldcoast, Australia