Methods of regulating albumin leakage during hemodiafiltration treatment.

Taoka Masahiro, Yamamoto Chieko, Kim Sung-Teh, Takasugi Masayuki

doi:10.4009/jsdt.34.1543

During hemodiafiltration (HDF) treatment, replacing large volumes using highly-permeable membranes tends to cause massive leakage of serum albumin. To investigate factors influencing albumin leakage, five-hour HDF treatment under various transmembrane pressure (TMP) conditions ranging from 50 to 350mmHg were performed in five chronically hemodialized patients, using polysulfone membrane with 250ml/min of blood flow rate. The fractional albumin loss in the dialysate was assayed during each session, which showed that the dialysate albumin concentration was highest during the initial five minutes with a steep decline over 60 minutes followel by a gradual decrease thereafter. In general, albumin leakage was greater with postdilution than with predilution under comparable TMP conditions. In each dilution method, albumin permeability increased with increases in TMP. Exceptionally, postdilutional HDF under 350mmHg of TMP caused less albumin leakage than that under TMPs of 150 and 250mmHg since aggressive filtration in the former caused greater pore fouling and narrowing. From these observations, filtration should be withheld during the first 5 minutes and then the ultrafiltration rate or TMP should gradually be increased over 60 minutes to predetermined values in order to maintain the total amount of albumin leakage below 4g during HDF treatment.

Methods of regulating albumin leakage during hemodiafiltration treatment.

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