Development of a dialyzer with enhanced internal filtration to increase the clearance of low molecular weight proteins.

Accumulated low molecular weight proteins in hemodialysis patients require a high-flux dialyzer. There have been several methods proposed for enhancing internal filtration, including narrowing the inside diameter of the hollow fibers, lengthening the fibers, and increasing the fiber density ratio. We tried to enhance the internal filtration by increasing the pressure drop in the dialysate compartment through increasing the fiber density ratio. If the fiber density ratio is too high, however, an irregular dialysate path may result, thus decreasing dialysis performance. Therefore, we took note of the shape of the inner housing and added a short taper structure, which improved the dialysate path dramatically. Consequently, we developed an internal filtration-enhanced dialyzer (APS-Prototype) to improve dialysis performance. The internal filtration rate in water (measured by Doppler ultrasound) was 13.2 l/session for the APS-Prototype and 5.3 l/session for the APS-15E. The amount of alpha1-microglobulin (alpha1-MG) in bovine plasma was 0.34 g for the APS-Prototype and 0.11 g for the APS-15E. In addition, the amount of alpha1-MG in vivo was 29.0% +/- 5.8% for the APS-Prototype, significantly higher than that for the APS-15E (13.6% +/- 1.9%). The desirable loss of albumin is 2-4 g in hemodiafiltration, and it was 3.92 +/- 1.03 g for the APS-Prototype. The prototype showed excellent solute removal performance with no clinical or engineering problems.