Modeling the transfer of low molecular weight plasma proteins during hemodialysis and online hemodiafiltration.

Abstract

Replacing the renal excretion of low molecular weight proteins (LMWP) by extracorporeal dialysis (dialysis) treatment poses technological challenges. Hemodialyzers with sieving coefficients for LMWP that match or even exceed those of the glomerular membrane barrier are commercially available; however, the associated losses of albumin are much higher than physiological levels of renal albumin excretion. A unidimensional, convection-diffusion model of solute transfer has been developed to analyze and quantitate LMWP extraction and albumin loss during dialysis treatment. The model is applicable to any extracorporeal dialysis technique and any type of hemodialyzer. Clinical extraction data for beta 2 microglobin (β2M, 11.6kDa), myoglobin (16.7kDa) and interleukin 6 (IL6, 21-30kDa) from 15 patients on hemodiafiltration (HDF) using a Nipro Elisio H series high flux hemodialyzer were analyzed using the model and values for the convection and mass transfer coefficients were derived. The model predicts that under normal clinical operating conditions, given equal amounts of β2M removal, albumin losses are higher using pre-dilution rather than post-dilution HDF. The model can be used to provide estimates of the internal filtration rates of hemodialyzers operating in vivo.