The Clinical Randomized Controlled Trial on the Safety and Efficacy of Polyethersulfone Membrane Dialyzer in the Maintenance of Hemodialysis Patients

Objective： To observe the safety and efficacy of polyethersulfone membrane dialyzer used by chronic renal failure patients in clinical maintenance hemodialysis （MHD）. Methods： From January to February 2009, 36 patients were recruited from Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. The experiment was approved by the ethnical committee of Xinhua Hospital and under permissions fronl patients. All the patients were randomized into polyethersulfone group （PES, n=18） and polysulfone group （PS, n=18）. Hemodialysis was given by using Fresenius 4008S capacity-controlled dialyser and ultra-purified bicarbonate dialysate, more than 3.5 h each time, three times per-week, followed by heparin anticoagulation for a week, three times totally. Changes in blood urea nitrogen （BUN）, serum creatinine （Set）, phosphate （p2＋）, hemoglobin and albumin levels were determined for the efficacy and safety evahlation. Results： The serum BUN, Set and p2＋ concentrations significantly reduced after hemodialysis with different dialyzers, and the decrease amplitude of two groups was equivalent（P〉0.05）. The clearance rate of the serum BUN and Scr had no significant difference among two groups（P〉O.05）. The clearance rate （ml/min） of the sermn P^2＋ was 144.57 ±27.83 v.s. 117.15 ±22.77 in two groups. The clearance rate of the serum p^2＋ in PES group was more than that in PS group, and the difference was significant between two groups （P=0.0001）. It was indicated that PES and PS membrane could efficiently eliminate serum mieromolecule solute in MHD patients, so PES membrane excelled PS membrane in eliminating serum p2＋. The hemodialysis safety index, for example serum hemoglobin, albumin and blood pressure, had no significant difference between the two groups before and after hemodialysis （P〉0.05）. Conclusion： The efficacy and safety of the PES hollow fiber membrane dialyzer is equivalent to that of the imported PS membrane dialyzer in hemodialysis for MHD patients. The PES membrane excels PS membrane in eliminating sermn p^2＋.

EXPERIMENT AND RESEARCH ON DEVELOPMENT AND CHARACTERIZATIONS OF ANODIC ALUMINA MEMBR-ANE FOR USE IN HEMODIALYSIS

Objective The correlation between various formative conditions and the pore characterizationsof the anodic alumina membrane is investigated to seek the optimal conditions for the formation of anodic aluminamembrane. Methods High purity aluminum foils are used as the starting materials. The anodization is conduc-ted in three types of electrolytes, 3% sulfuric acid, 5% sulfuric acid and 2. 7% oxalic acid, respectively, with dif-ferent voltages at for 48h. The characterizations of the pore size, the effective porosity and the pore porosity areobserved and determined by scanning electron microscopy. The hydraulic conductances of the membranes are meas-ured to confirm that the pores are open and evaluate the permselectivity of the membranes. Results The experi-mental result shows that the ordered pore arrays are obtained for oxidation under our experimental conditions. Withthe increasing of the voltage, the pore size and pore porosity increased significantly (P <0.05) , while the effectiveporosity decreased significantly (P <0.05) with the same electrolyte. The pore size formed in 3% sulfuric acid or5% sulfuric acid is much smaller than in 2. 7% oxalic acid as an electrolyte. The hydraulic conductance of anodicalumina membrane that formed under our experimental condition is higher than those of the membranes are availablecurrently used in clinical. Conclusion The results suggest that the optimal conditions for the formation of anodicalumina membrane that used in hemodialysis are in 3% or 5% sulfuric acid with 12. 5V to 17. 5V at for 48h.

Synergetic effect of dialyzer membrane and lipopolysaccharide on peripheral blood mononuclear cell cytokine production in uremic patients

To investigate the effect of lipopoly^saccharide(LPS) and dialyzer membrane on cytokine gene expression and protein production in uremic patients on continuous ambulatory peritoneal dialysis(CAPD) and regular hemodialysis(HD) Methods Interleukin 1β(IL 1β) and interleukin 1 receptor antagonist(IL 1Ra) produced by cultured peripheral blood mononuclear cells(PBMC) after exposure to cuprammonium(Cup) membrane, polysulfone(PS) membranes or endotoxin were detected using enzyme linked immunoabsorbent assay mRNA expression was determined simultaneously by in situ hybridiztion Results In the absence of endotoxin, a small amount of IL 1β and IL 1Ra was produced by PBMC harvested from HD and CAPD patients after incubation with Cup or PS during subsequent 24 hour culture For healthy controls, IL 1β was barely detectable just above the detection limit Although no differences could be found in protein synthesis between Cup and PS, in situ hybridization showed that Cup induced markedly higher level mRNA coding for IL 1β and IL 1Ra In contrast, when subsequently stimulated with endotoxin, PBMC incubated with Cup could produce significantly larger amount of IL 1β and IL 1Ra compared with either unstimulated cells or post incubation PBMC with PS LPS stimulated PBMC in healthy subjects produced similar amount of IL 1β and markedly lower IL 1Ra as compared with uremic patients on HD and CAPD Conclusions Two steps are required in healthy control for IL 1β and IL 1Ra production: induction of mRNA transcription by membrane contact, followed by LPS induced translation, while in uremic patients on HD or CAPD bioincompatibility membrane and LPS have a synergetic effect on IL 1β and IL 1Ra production There exists an unbalance between IL 1β and its specific inhibitor in maintenance dialysis patients