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Abstract
Protein and calorie malnutrition are prevalent in chronic hemodialysis (HD) patients
and has been linked to increased mortality and morbidity in this patient population.
Concern has been raised that the open pore structure of high flux membranes may induce
the loss of more amino acids (AA) compared to low flux membranes. To address this
issue, we prospectively analyzed pre- and post-HD plasma AA profiles with three different
membranes in nine patients. Simultaneously, we measured dialysate AA losses during
HD. The membranes studied were: cellulosic (cuprophane-CU), low flux polymethylmethacrylate
(LF-PMMA), and high flux polysulfone (HF-PS) during their first use. Our results show
that pre-HD plasma AA profiles were abnormal compared to controls and decreased significantly
during HD with all dialyzers. The use of HF-PS membranes resulted in significantly
more AA losses into the dialysate when compared to LF-PMMA membranes (mean +/- SD;
8.0 +/- 2.8 g/dialysis for HF-PS, 6.1 +/- 1.5 g/dialysis for LF-PMMA, p < 0.05, and
7.2 +/- 2.6 g/dialysis for CU membranes, P = NS). When adjusted for surface area and
blood flow, AA losses were not different between any of the dialyzers. We also measured
dialysate AA losses during the sixth reuse of the HF-PS membrane. Losses of total
AA increased by 50% during the sixth reuse of HF-PS membrane compared to its first
use. In addition, albumin was detected in the dialysate during the sixth reuse of
HF-PS membrane. We therefore measured albumin losses in all patients dialyzed with
HF-PS membranes as a function of reuse.(ABSTRACT TRUNCATED AT 250 WORDS)