Biomedical Engineering Advances (Jun 2022)
Novel insights in hemodialysis: Most recent theories on membrane hemocompatibility improvement
Abstract
Kidney failure patients or patients with end-stage renal diseases (ESRD), need hemodialysis (HD) as a life-sustaining service. However, the morbidity and mortality rates are still high and unacceptable. Several academic efforts and various types of research have targeted the improvement of blood purification technologies in general and HD technologies more specifically. Major concerns are attributed to the incompatibility of the materials used in membrane filters as the main element of the HD systems. Elevated levels of cytokines and inflammatory markers as the result of bloodstream-membrane incompatibility, are attributed to several side-effects and cardiovascular shocks in the patients. Computational efforts along with new hypothesizes are published recently. The novel efforts in the field are suggesting a different behavior of water as the reason of hemocompatibility of the membrane. Accordingly, the membranes’ hydrophilicity or the thickness of the hydration layer (as the previous understanding of the field) is not responsible for the compatibility with the blood. New findings are suggesting that the stability of the water is more important to protect human serum proteins from interaction with the polymeric membranes. This critical review intends to cover the most recent understandings in the field with the goal of shedding light on the futures direction. This short review covers the new insight to hemocompatibility measure, i.e., intermediate water molecule and the mechanism of intermediate water-assisted hemocompatibility improvement. Furthermore, the review covers the nature of the human serum proteins from the dialysis point of view and how they get denatured by uremic metabolites. The role of hydration layer of both human serum proteins and the polymeric membranes is discussed. In addition, the probable hemocompatibility improvement framework is suggested.
