Influence of UV-irradiation intensity and exposure duration on the hemobiocompatibility enhancement of a novel synthesized phosphobetaine zwitterions polyethersulfone clinical hemodialysis membranes

Impact of Membrane Modification and Surface Immobilization Techniques on the Hemocompatibility of Hemodialysis Membranes: A Critical Review

Despite significant research efforts, hemodialysis patients have poor survival rates and low quality of life. Ultrafiltration (UF) membranes are the core of hemodialysis treatment, acting as a barrier for metabolic waste removal and supplying vital nutrients. So, developing a durable and suitable membrane that may be employed for therapeutic purposes is crucial. Surface modificationis a useful solution to boostmembrane characteristics like roughness, charge neutrality, wettability, hemocompatibility, and functionality, which are important in dialysis efficiency. The modification techniques can be classified as follows: (i) physical modification techniques (thermal treatment, polishing and grinding, blending, and coating), (ii) chemical modification (chemical methods, ozone treatment, ultraviolet-induced grafting, plasma treatment, high energy radiation, and enzymatic treatment); and (iii) combination methods (physicochemical). Despite the fact that each strategy has its own set of benefits and drawbacks, all of these methods yielded noteworthy outcomes, even if quantifying the enhanced performance is difficult. A hemodialysis membrane with outstanding hydrophilicity and hemocompatibility can be achieved by employing the right surface modification and immobilization technique. Modified membranes pave the way for more advancement in hemodialysis membrane hemocompatibility. Therefore, this critical review focused on the impact of the modification method used on the hemocompatibility of dialysis membranes while covering some possible modifications and basic research beyond clinical applications.

Impact of Dialysis Clinical Operating Conditions on Human Serum Protein-Mediated Inflammatory Biomarkers Released in Patients Using Polyarylethersulfone Membranes

Hemodialysis (HD) is a life-sustaining treatment of crucial importance in managing end-stage renal disease (ESRD). However, this membrane-based therapy is associated with acute side-effects due to bioincompatibility issues and limitations on the removal of uremic toxins. The present study assessed the influence of hydrodynamic conditions applied during HD treatment on protein-mediated inflammatory and thrombotic responses. The membrane modules considered are commonly used in Canadian hospitals and are comprised of a polymer blend of polyarylether sulfone-polyvinylpyrrolidone (PAES). The membranes morphology and hydrophilicity were assessed using SEM, AFM, BET, and zeta potential. An in vitro study evaluated the adsorptive behavior of fibrinogen (FB) to the membrane under different flow conditions. Lower rates of 200 mL/min promoted slower and significant FB adsorption, leading to more severe inflammatory and thrombotic responses. Hydrodynamic conditions also affected the concentration of all inflammatory biomarkers. Lower flow rates triggered more complement activation as well as coagulation, clotting, and inflammatory responses compared to higher flow rates. At the end of the dialysis session, patients treated with a Qb of 200 mL/min presented a significant increase in the concentration of C5a (232%), properdin (114%), serpin (545%), IL-1α (50%), IL-6 (450%), and vWF (212%). IL-1β and TNF-α concentrations declined by 12.5 and 35.5%, respectively. Male patients experienced more severe inflammatory responses than female patients at the operating conditions considered. Comparing the pre- and post-dialysis levels of female and male patients, female patients experienced significantly higher levels of IL-6 and properdin, while male patients presented higher levels of C5a, IL-1α, and IL-6. The results of this study will help clinical doctors evaluate the impact of HD operating conditions on blood activations before prescribing treatment and inform expectations for outcomes in female and male patients.