Search Results (47)

Introduction: Expanded hemodialysis using medium cut-off (MCO) dialyzers effectively removes middle-molecule uremic toxins, comparable to hemodiafiltration, but their single-use designation increases the dialysis costs. This study evaluated the efficacy and safety of reusing two MCO dialyzers available in Thailand. Methods: In this randomized controlled trial, hemodialysis patients were assigned to receive treatment with either Theranova^® 500 or Elisio^® 21HX dialyzers. Each dialyzer was reprocessed using peracetic acid and reused for up to 15 sessions. Dialyzer performance was assessed by the reduction ratios (RRs) of solutes, including β2-microglobulin (β2-MG), kappa and lambda free light chains (κ-FLC, λ-FLC), and interleukin-6 (IL-6), at baseline and the 2nd, 5th, 10th, and 15th sessions. Results: Forty-eight patients were enrolled (mean age 63.6 ± 13.7 years; 62.5% male) and randomized into 2 groups with comparable baseline characteristics. RRs for β2-MG, κ-FLC, and λ-FLC were similar between the groups and declined modestly over time after dialyzer reused (β2-MG: 78.2% to 72.5% vs. 77.2% to 74.5%, κ-FLC: 64.6% to 51.3% vs. 58.9% to 49.5%, and λ-FLC: 51.2% to 46.4% vs. 49.4% to 39.2% in the Theranova^® 500 and Elisio^® 21HX groups, respectively). Theranova^® 500 demonstrated significantly higher IL-6 clearance in the 2nd (29.9% vs. 16.0%; p = 0.018) and 5th (23.8% vs. 7.7%, p = 0.031) sessions. It also showed a non-significant trend toward lower dialyzer survival (HR 3.98; p = 0.085) and higher, though clinically acceptable, albumin loss (mean difference 0.56 g/session; p < 0.001), which decreased with reuse. Conclusions: Both MCO dialyzers demonstrated comparable overall performance during reuse. Theranova^® 500 provided better IL-6 clearance with manageable albumin loss. Implementation of high-quality dialyzer reuse protocols may optimize clinical efficacy and patient outcomes while balancing cost, accessibility, and environmental considerations. Full article

Innovation in dialysis care is fundamental to improve well-being and outcomes of patients with end-stage kidney disease. The dialyzer is the core element of dialysis treatments, as it largely defines which substances are removed from the patient’s body. Moreover, its large surface size is the major place of interaction of the patient’s blood with artificial surfaces and thus may lead to undesired effects such as inflammation or coagulation. In the present article we summarize the development path for a new dialyzer, including in vitro and clinical evidence generation. We use the example of the novel FX CorAL dialyzer, which has recently entered European and US markets, to show which steps are needed to develop and characterize a new dialyzer. The FX CorAL dialyzer includes a new hydrophilic membrane, which features reduced protein adsorption, sustained performance, and an improved hemocompatibility profile, characterized in numerous in vitro and clinical studies. Safety evaluations revealed a favorable profile, with low incidences of adverse device effects. Insights gained from both in vitro and clinical studies contribute to the advancement of dialyzer development, ultimately leading to improved patient care. Full article

As chronic kidney disease (CKD) prevalence rises, optimizing hemodialysis remains essential. While online hemodiafiltration (OL-HDF) is the gold standard, expanded hemodialysis (HDx), i.e., using high-performance dialyzers in standard hemodialysis, remains the most common clinical practice. Medium cutoff (MCO) membranes aim to enhance middle-molecule removal while preserving protein selectivity, although most studies evaluate them in OL-HDF. To this end, this study aims to compare the Xevonta-Hi (B. Braun), a high-flux (HF) polysulfone dialyzer, and the ELISIO-HX (Nipro), an MCO polyethersulfone dialyzer, in standard hemodialysis. In a prospective, observational study, seven stable patients sequentially received treatment with each dialyzer over four weeks. Pre- and post-dialysis levels of small and middle uremic molecules and inflammatory markers—including procalcitonin, prolactin, serum amyloid A, placental growth factor, interleukin-6, haptoglobin, ceruloplasmin, transferrin, prealbumin, and C-reactive protein—were measured. Both dialyzers demonstrated excellent clearance of small and middle molecules, with no significant differences in efficacy. Albumin and total protein losses remained minimal. Moderate reductions in serum amyloid A, placental growth factor, and interleukin-6 were observed, while no significant reductions occurred in the remaining inflammatory markers. These findings support the safety and effectiveness of both MCO and HF dialyzers in standard hemodialysis. Full article

Introduction: Recent studies have discovered that lung cancer subtypes possess distinct microbiome profiles within their tumor microenvironment. Additionally, the tumor-associated microbiome exhibits altered bacterial pathways, suggesting that certain bacterial families are more capable of facilitating tumor progression than others. We hypothesize that there exists a crosstalk between lung adenocarcinoma (LUAD) cells and bacterial cells. Methods and Materials: RNA sequencing (RNA-seq) was performed on LUAD cell lines to explore the paracrine signaling effects of bacterial biomolecules. Based on our RNA-seq data, we investigated glycolysis by measuring glucose uptake and lactate production, invasive potential through invasion assays, and epithelial-to-mesenchymal transition (EMT) markers. Since lipopolysaccharides (LPS), abundant on the cell walls of Gram-negative bacteria, can activate toll-like receptor 4 (TLR4), we inhibited TLR4 with C34 to assess its relationship with the observed phenotypic changes. To identify the bacterial biomolecules responsible for these changes, we treated the media with RNAse enzyme, charcoal or dialyzed away molecules larger than 3 kDa. Results and Discussion: RNA-seq revealed 948 genes upregulated in the presence of E. coli biomolecules. Among these, we observed increased expression of Hexokinase II (HKII), JUN proto-oncogene, and Snail Family Transcriptional Repressor 1. We verified the elevation of glycolytic enzymes through Western blot and saw elevation of 2-deoxyglucose uptake and lactate production in LUAD cell lines incubated in E. coli biomolecules. In addition to E. coli elevating glycolysis in LUAD cell lines, E. coli exposure enhanced invasive potential as demonstrated by Boyden chamber assays. Notably, inhibition of TLR4 did not reduce the impact of E. coli biomolecules on glycolysis or the invasive potential of LUAD. Modulating the E. coli-supplemented media with RNAse enzyme or dextran-coated charcoal or using a spin column to remove biomolecules smaller than 3 kDa resulted in changes in HKII and Claudin protein expression. These findings suggest a direct relationship between E. coli and LUAD, wherein several cancer hallmarks are upregulated. Future studies should further investigate these bacterial biomolecules and their role in the tumor microenvironment to fully understand the impact of microbial shifts on cancer progression. Full article

The dialysis membrane based on a hydrophilic polymer (Hydrolink NV) was designed to enhance the movement of adsorbed water at the blood–membrane interface, aiming to achieve antithrombogenic and antifouling effects. This study aimed to assess the performance and albumin loss of the Hydrolink NV dialyzer in hemodialysis (HD) and post-dilution hemodiafiltration (HDF) with different infusion flows (Qis) and compare it with the hydrophilic FX CorAL dialyzer in post-dilution HDF. A prospective study was carried out in 20 patients. Patients underwent five dialysis sessions with the same routine dialysis parameters: four sessions with the Toraylight NV 2.1 (HD, post-dilution HDF with 50, 75 or auto-substitution Qi) and one with the FX CorAL 800 (post-dilution HDF with auto-substitution Qi). The reduction ratios’ (RRs’) wide range of molecular weight molecules were assessed and the dialysate albumin loss was quantified. The lowest β₂-microglobulin, indoxyl-sulfate, and p-cresyl sulfate RR values were observed with the Toraylight NV 2.1 in HD, and they improved progressively with an increased Qi, without differences being observed between the two dialyzers in auto-substitution. A different removal profile was observed in terms of myoglobin, kFLC, prolactin, α₁-microglobulin, α₁-acid glycoprotein, and λFLC, whose RRs also improved progressively with an increased Qi but were significantly higher with the Toraylight NV than the CorAL in the same convective condition. There were significant differences in the albumin dialysate losses, with the highest value obtained with the Toraylight NV in auto-substitution HDF, with more than 50% of patients surpassing 5 g per session. The Toraylight NV dialyzer has great potential for efficacy but should be used at the optimal convective volume (Qi not exceeding 75 mL/min or FF not exceeding 25%) to avoid excessive albumin loss. Full article

Hemodialysis (HD) is a critical treatment for patients with end-stage kidney disease (ESKD). The effectiveness of conventional dialyzers used there could be compromised during extended use due to limited blood compatibility of synthetic polymeric membranes and sub-optimal dialyzer design. In fact, blood flow in the hollow fiber (HF) membrane could trigger inflammatory responses and thrombus formation, leading to reduced filtration efficiency and limiting therapy duration, a consequence of flowing the patients’ blood through the lumen of each fiber while the dialysate passes along the inter-fiber space (IOF, inside-out filtration). This study investigates the development of HF membranes for “outside-in filtration” (OIF) in HD. In OIF, blood flows through the inter-fiber space while dialysate flows within the fiber lumens, reducing the risk of fiber clogging and potentially extending treatment duration. For the OIF mode, the membrane should have a blood-compatible outer selective layer in contact with the patient’s blood. We develop HFs for OIF via liquid-induced phase separation using PES/PVP (polyethersulphone/polyvinylpyrrolidone) blends. The fibers’ surface morphology (SEM, scanning electron microscopy), chemistry (ATR-FTIR—attenuated total reflection-Fourier transform infrared spectroscopy, XPS—X-ray photoelectron spectroscopy), transport properties, and uremic toxin removal from human plasma are evaluated and compared to commercial HFs. These membranes feature a smooth, hydrophilic outer layer, porous lumen, ultrafiltration coefficient of 13–34 mL m² h⁻¹ mmHg⁻¹, adequate mechanical properties, low albumin leakage, and toxin removal performance on par with commercial membranes in IOF and OIF. They offer potential for more efficient long-term HD by reducing clogging and systemic anticoagulation needs and enhancing treatment time and toxin clearance. Full article

The relevance of the hemodialysis procedure is increasing worldwide due to the growing number of patients suffering from chronic kidney disease. Taking into account the structure of dialysis polymer membranes is an important aspect in their development to achieve the required performance of hemodialyzers. We propose a new mathematical model of mass transfer that allows hollow-fiber membrane structural parameters to be taken into account in simulating the clearance (CL) of hemodialyzers in a way that does not require difficult to achieve close approximation to the exact geometry of the membrane porous structure. The model was verified by a comparison of calculations with experimental data on $CL$ obtained using a lab-made dialyzer as well as commercially available ones. The simulations by the model show the non-trivial behavior of the dialyzer clearance as a function of membrane porosity ($f_p$) and the arrangement of pores ($\alpha$). The analysis of this behavior allows one to consider two strategies for increasing the $CL$ of the dialyzer by optimizing the polymer membrane structure: (1) creating a membrane with a well-structured pore system (where $\alpha$ → 1) since doubling $\alpha$ at a high enough $f_p$ can lead to an almost tenfold increase in $CL$; (2) increasing the porosity of the membrane characterized by a random arrangement of pores ($\alpha$ → 0), where, at a relatively low $\alpha$, a sharp increase in $CL$ is observed with a small increase in $f_p$ over a certain threshold value. Full article

It has been estimated that in 2010, over two million patients with end-stage kidney disease may have faced premature death due to a lack of access to affordable renal replacement therapy, mostly dialysis. To address this shortfall in dialytic kidney replacement therapy, we propose a novel, cost-effective, and low-complexity hemodialysis method called allo-hemodialysis (alloHD). With alloHD, instead of conventional hemodialysis, the blood of a patient with kidney failure flows through the dialyzer’s dialysate compartment counter-currently to the blood of a healthy subject (referred to as a “buddy”) flowing through the blood compartment. Along the concentration and hydrostatic pressure gradients, uremic solutes and excess fluid are transferred from the patient to the buddy and subsequently excreted by the healthy kidneys of the buddy. We developed a mathematical model of alloHD to systematically explore dialysis adequacy in terms of weekly standard urea Kt/V. We showed that in the case of an anuric child (20 kg), four 4 h alloHD sessions are sufficient to attain a weekly standard Kt/V of >2.0. In the case of an anuric adult patient (70 kg), six 4 h alloHD sessions are necessary. As a next step, we designed and built an alloHD machine prototype that comprises off-the-shelf components. We then used this prototype to perform ex vivo experiments to investigate the transport of solutes, including urea, creatinine, and protein-bound uremic retention products, and to quantitate the accuracy and precision of the machine’s ultrafiltration control. These experiments showed that alloHD performed as expected, encouraging future in vivo studies in animals with and without kidney failure. Full article

Microfluidic devices promise to overcome the limitations of conventional hemodialysis and oxygenation technologies by incorporating novel membranes with ultra-high permeability into portable devices with low blood volume. However, the characteristically small dimensions of these devices contribute to both non-physiologic shear that could damage blood components and laminar flow that inhibits transport. While many studies have been performed to empirically and computationally study hemolysis in medical devices, such as valves and blood pumps, little is known about blood damage in microfluidic devices. In this study, four variants of a representative microfluidic membrane-based oxygenator and two controls (positive and negative) are introduced, and computational models are used to predict hemolysis. The simulations were performed in ANSYS Fluent for nine shear stress-based parameter sets for the power law hemolysis model. We found that three of the nine tested parameters overpredict (5 to 10×) hemolysis compared to empirical experiments. However, three parameter sets demonstrated higher predictive accuracy for hemolysis values in devices characterized by low shear conditions, while another three parameter sets exhibited better performance for devices operating under higher shear conditions. Empirical testing of the devices in a recirculating loop revealed levels of hemolysis significantly lower (<2 ppm) than the hemolysis ranges observed in conventional oxygenators (>10 ppm). Evaluating the model’s ability to predict hemolysis across diverse shearing conditions, both through empirical experiments and computational validation, will provide valuable insights for future micro ECMO device development by directly relating geometric and shear stress with hemolysis levels. We propose that, with an informed selection of hemolysis parameters based on the shear ranges of the test device, computational modeling can complement empirical testing in the development of novel high-flow blood-contacting microfluidic devices, allowing for a more efficient iterative design process. Furthermore, the low device-induced hemolysis measured in our study at physiologically relevant flow rates is promising for the future development of microfluidic oxygenators and dialyzers. Full article

While efficient removal of uremic toxins and accumulated water is pivotal for the well-being of dialysis patients, protein adsorption to the dialyzer membrane reduces the performance of a dialyzer. Hydrophilic membrane modification with polyvinylpyrrolidone (PVP) has been shown to reduce protein adsorption and to stabilize membrane permeability. In this study we compared middle molecule clearance and filtration performance of nine polysulfone-, polyethersulfone-, and cellulose-based dialyzers over time. Protein adsorption was simulated in recirculation experiments, while β2-microglobulin clearance as well as transmembrane pressure (TMP) and filtrate flow were determined over time. The results of this study showed that β2-microglobulin clearance (−7.2 mL/min/m²) and filtrate flow (−54.4 mL/min) decreased strongly during the first 30 min and slowly afterwards (−0.7 mL/min/m² and −6.8 mL/min, respectively, for the next 30 min); the TMP increase (+37.2 mmHg and +8.6 mmHg, respectively) showed comparable kinetics. Across all tested dialyzers, the dialyzer with a hydrophilic modified membrane (FX CorAL) had the highest β2-microglobulin clearance after protein fouling and the most stable filtration characteristics. In conclusion, hydrophilic membrane modification with PVP stabilizes the removal capacity of middle molecules and filtration performance over time. Such dialyzers may have benefits during hemodiafiltration treatments which aim to achieve high exchange volumes. Full article

Worldwide, the number of elderly individuals receiving chronic hemodialysis is rising. The aim of our study was to evaluate several clinical and analytical biomarkers in chronically dialyzed patients and analyze how they change with age. A cross-sectional study was performed by evaluating 289 end-stage renal disease patients undergoing dialysis. We evaluated the hemogram, adipokines, the lipid profile, and several markers related to inflammation, endothelial function/fibrinolysis, nutrition, iron metabolism, and cardiac and renal fibrosis. Clinical data and dialysis efficacy parameters were obtained from all patients. The relationships between studied biomarkers and age were assessed by a statistical comparison between younger (adults with age < 65 years) and older (age ≥ 65 years) patients and by performing regression analysis. Participants presented a mean age of 68.7 years (±13.6), with 66.8% (n = 193) being classified as older. Compared to younger patients, older patients presented the following: (a) significantly lower values of diastolic blood pressure (DBP) and ultrafiltration volume; (b) lower levels of phosphorus, uric acid, creatinine, and albumin; and (c) higher circulating concentrations of tissue-type plasminogen activator (tPA), D-dimer, interleukin-6, leptin, N-terminal pro B-type natriuretic peptide, and tissue inhibitor of metalloproteinase-1. In the multiple linear regression analysis, DBP values, tPA, phosphorus, and D-dimer levels were independently associated with the age of patients (standardized betas: −0.407, 0.272, −0.230, and 0.197, respectively; p < 0.001 for all), demonstrating relevant changes in biomarkers with increasing age at cardiovascular and nutritional levels. These findings seem to result from crosstalk mechanisms between aging and chronic kidney disease. Full article

Microelectromechanical systems (MEMS)-based filter with microchannels enables the removal of various microorganisms, including viruses and bacteria, from fluids. Membranes with porous channels can be used as filtration interfaces in MEMS hemofilters or mini-dialyzers. The main problems associated with the filtration process are optimization of membrane geometry and fouling. A nanoporous aluminum oxide membrane was fabricated using an optimized two-step anodization process. Computational strength modeling and analysis of the membrane with specified parameters were performed using the ANSYS structural module. A fuzzy simulation was performed for the numerical analysis of flux through the membrane. The membrane was then incorporated with the prototype for successive filtration. The fluid flux and permeation analysis of the filtration process have been studied. Scanning electron microscope (SEM) micrographs of membranes have been obtained before and after the filtration cycles. The SEM results indicate membrane fouling after multiple cycles, and thus the flux is affected. This type of fabricated membrane and setup are suitable for the separation and purification of various fluids. However, after several filtration cycles, the membrane was degraded. It requires a prolonged chemical cleaning. High-density water has been used for filtration purposes, so this MEMS-based filter can also be used as a mini-dialyzer and hemofilter in various applications for filtration. Such a demonstration also opens up a new strategy for maximizing filtration efficiency and reducing energy costs for the filtration process by using a layered membrane setup. Full article

Membrane dialysis is one of the membrane contactors applied to wastewater treatment. The dialysis rate of a traditional dialyzer module is restricted because the solutes transport through the membrane only by diffusion, in which the mass-transfer driving force across the membrane is the concentration gradient between the retentate and dialysate phases. A two-dimensional mathematical model of the concentric tubular dialysis-and-ultrafiltration module was developed theoretically in this study. The simulated results show that the dialysis rate improvement was significantly improved through implementing the ultrafiltration effect by introducing a trans-membrane pressure during the membrane dialysis process. The velocity profiles of the retentate and dialysate phases in the dialysis-and-ultrafiltration system were derived and expressed in terms of the stream function, which was solved numerically by the Crank–Nicolson method. A maximum dialysis rate improvement of up to twice that of the pure dialysis system ($V_w=0$) was obtained by employing a dialysis system with an ultrafiltration rate of $V_w=2 \mathrm{m}\mathrm{L}/\mathrm{m}\mathrm{i}\mathrm{n}$ and a constant membrane sieving coefficient of $\theta =1$. The influences of the concentric tubular radius, ultrafiltration fluxes and membrane sieve factor on the outlet retentate concentration and mass transfer rate are also illustrated. Full article

Silk fibroin nanoparticles (SFN) have become a promising tool in drug delivery systems due to their physicochemical characteristics. SFN have shown their outstanding properties as an active vehicle for polyphenols, enhancing their antioxidant and anti-inflammatory effects on macrophages; therefore, it becomes necessary to have an easy, reproducible and scalable production method. In order to improve the production of nanoparticles, we performed direct precipitation of non-dialyzed silk fibroin solutions and evaluated the reproducibility of the method using dynamic light scattering. We also studied the loading efficiency of three different natural polyphenols using propylene glycol as a solvent. The loaded nanoparticles were fully characterized and used to treat human macrophage cells to assess the anti-inflammatory activity of these nanoparticles. The measured hydrodynamic characteristics of the SFN and the overall yield of the process showed that the new preparation method is highly reproducible and repeatable. Thus, we not only present a new scalable method to prepare silk nanoparticles but also how to improve the loading of natural polyphenolic compounds to the SFN, as well as the important anti-inflammatory effects of these loaded nanoparticles in a cell model of human macrophage cells. Full article

The isolation and chemical characterization of phlorotannins has gained special attention in recent years due to their specific health-promoting benefits. Flow-cell ultrasound-assisted extraction (90 W/cm² of sonication power, 2 min of retention time and 20 g solvent/g algae of liquid–solid ratio) was carried out by using double-distilled water (WE) and acetone:water mixture (AWE) as extraction solvents. The AWE showed a higher total polyphenols content (TPC), carbohydrates (CHOs) and antioxidant activities than WE. However, when the WE was purified by using Amberlite XAD16 column, the purified WE (PWE) showed similar a TPC, decreased CHOs and increased antioxidant activity compared to WE. The oxidation of the PWE extract was evaluated under natural, forced and severe oxidation condition for 120 h. Only severe oxidation conditions were able to significantly reduce TPC and antioxidant activities. PWE was dialyzed (20, 10, 3.5 and 2 kDa). The main bioactive fraction of phlorotannins was obtained from 10 to 20 kDa. CHOs were distributed in fractions below 20 kDa. MALDI-TOF analysis was performed for PWE, PD20 and PD2 extracts to analyze the degree of polymerization of phlorotannins, which ranged from 4 to 17 phloroglucinol units/molecule. Fragmentation patterns allowed the proximate identification of several phlorotannins in Ascophyllum nodosum extracts. Full article