Structure, function, and adsorption of highly abundant blood proteins and its critical influence on hemodialysis patients: A critical review

Abstract

Adsorption of blood proteins during hemodialysis (HD) triggers activation of biochemical cascades and reduces treatment efficacy due to membrane fouling. Complement and coagulation cascades lead HD patients into an inflammatory state that can negatively impact protein synthesis and lead to severe outcomes. This critical review aims to critique scientific insights regarding protein adsorption during HD and its potential impact on patients. The influence of protein structure, function, and adsorption on HD membranes on HD patients’ health has been reviewed. We focused on human serum albumin, transferrin, and fibrinogen for their abundance in human blood and known participation in the biochemical reactions. The occurrence of the Vroman effect specifically in the context of HD and the state-of-the-art techniques to further elucidate the mechanisms of competitive adsorption has been comprehensively discussed. The interconnectedness between the role of each protein is elucidated and should aid the understanding of adsorption mechanics and the development of biocompatibility enhancement strategies.

Keywords

• albumin
• biocompatibility
• fibrinogen
• transferrin
• hemodialysis membranes